Oral
Answers to
Questions

TRANSPORT

The Secretary of State was asked—

Rail Fares

Graham Jones: What steps he is taking to simplify rail fares.

Jo Johnson: The hon. Gentleman will be aware that, by the end of 2018, almost all passengers will have the choice of a smart ticket, making buying a ticket easier and giving passengers much greater choice.

Graham Jones: What plans does the Minister have to ensure that split ticketing does not erode trust in the rail fare system? How can he ensure that ticket machines on the East Lancs line provide the cheapest option to passengers when there are not necessarily offices to buy tickets from?

Jo Johnson: Simplification of ticketing and ease of understanding for passengers is extremely important, as is ensuring that passengers have access to the fares that are right for them. It is important that train operating companies look carefully at their ticketing arrangements to ensure that that is the case.

Desmond Swayne: Is simpler necessarily cheaper? Because if there is a choice…

Jo Johnson: Simpler may be cheaper, and there may also be circumstances in which it leads to cost increases. It is important that we achieve a system that is comprehensible, in which passengers do not have to struggle for hours to work out which ticket is the right one for them. Following the 2016 fares and ticketing action plan, we introduced advance tickets for sale on the day of travel that benefit hundreds of thousands of passengers.

John Bercow: I think we will take that as a no.

Peter Kyle: I am grateful for the Minister’s letter of this week, saying that his Department is taking on extra resource to simplify the fare structure on the Brighton main line. Will he reassure passengers in the area that that simplification will involve the rounding down of fares, not just rounding up? Will he also tell passengers when they can expect the review to complete?

Jo Johnson: I can indeed confirm that the Department has taken on additional resource specifically to address the anomalies within the Govia Thameslink Railway fare structure. As the hon. Gentleman said, there will be a review in order to simplify the structure, with particular reference to complications on that route. We are working with GTR to achieve this as rapidly as we can.

West Coast Main Line

Michael Fabricant: What his policy is on the operation of passenger services on the west coast main line after the completion of High Speed 2; and if he will make a statement.

Chris Grayling: As my hon. Friend knows, once High Speed 2 comes into operation it will move the express trains off the existing west coast main line and on to the new route. That will provide a great opportunity to improve services to intermediate stops such as Lichfield that do not have a good enough service at the moment.

Michael Fabricant: I am slightly reassured by that answer. The Secretary of State talks about moving express trains off the west coast main line, but of course we currently have a very good Pendolino service and the slower West Midlands trains. Several hundred of my constituents commute to London every single day. What assurance can the Secretary of State give them that the Pendolino service—a fast, express service—will continue, and indeed that the Pendolinos will be replaced with equally fast trains when they come to the end of their life cycle?

Chris Grayling: The Pendolinos have many years to go, and I have no doubt that they will be replaced by a high-quality fast train in the future. My hon. Friend will have stood on the platform at Lichfield station and seen trains to Liverpool, Manchester and Scotland zooming past at high speed. The new plans will provide an opportunity for more trains to stop at Lichfield.

Barry Sheerman: The Secretary of State knows well that I believe that HS2 is a vanity project that will never come to fruition. He knows that my constituents in the booming town of Huddersfield, which he visited recently, have access to the west coast line and the east coast line, but most of all they want a good trans-Pennine connection everywhere.

Chris Grayling: Absolutely, which is why I have already announced that the £2.9 billion upgrade of the trans-Pennine line will begin this time next year, as the start of a transformation that is vital to the north. In the coming months we will also see the arrival of the first of a complete new set of trains across the north of England that will transform passengers’ experience.

Alan Brown: Previously I have raised concerns that, under the Department’s current proposals, high-speed classic-compatible trains will run slower north of Crewe than existing trains on the west coast main line just now. The Secretary of State said that we need to address that as we go through the 2020s. That is clearly not good  enough. We need certainty now. If he will not commit to upgrading the west coast main line north of Crewe, will he look into procuring trains that can tilt and travel on the high-speed network?

Chris Grayling: The new classic-compatible trains and the arrival of HS2 up to the north-west of England will of course mean more speedy journey times to Scotland. I know the hon. Gentleman’s party’s view. We want to see further improvements through the 2020s to the west coast main line north of Crewe to ensure that we improve journey times. We want the best possible journey times across the whole network, and will continue to work for that.

HS2: Chesterfield Canal Land Purchase

Toby Perkins: What information his Department holds on plans by HS2 Ltd to purchase land close to Chesterfield canal; and if he will make a statement.

Nusrat Ghani: HS2 Ltd will bring forward a draft environmental statement for phase 2b later this year, which will provide greater detail on the land requirements for the construction, maintenance and operation of phase 2b of HS2 and proposed mitigation. This will then be consulted on, and HS2 Ltd will continue to seek the input of landowners, local communities and stakeholders as the design of the railway is developed.

Toby Perkins: HS2 is an incredibly important regeneration project, but so is Chesterfield canal, which has had five years of blight, being unable to make applications because of the uncertainty around HS2. Near the maintenance depot that is proposed for Staveley, there is a piece of land currently owned by Network Rail that needs to pass over to HS2. May I encourage the Minister to ask HS2 to get on with taking over ownership of that land so that Chesterfield canal can finally put forward plans to apply for new funding and reduce that blight?

Nusrat Ghani: Let me assure the hon. Gentleman that HS2 Ltd is working with Chesterfield Canal Trust and is committed to finding a solution. HS2 Ltd will be more than happy to meet him to discuss the Staveley design proposals and the interface with Chesterfield canal. I also assure him, however, that Chesterfield Canal Trust has recently publicly said that it is pleased with the recent commitment from HS2 Ltd and is now more confident that a solution will be found.

Dennis Skinner: Two HS2 lines go through Derbyshire—the one that goes through Newton and the other that is now apparently going to create difficulties on Chesterfield canal. We have heard reference to the question of the real cost of HS2, as it changes quite often. What is the latest cost, taking into account those two railway tracks through Derbyshire?

Nusrat Ghani: As I said, Chesterfield Canal Trust is working with HS2 Ltd and is happy with the relationship they have and the potential outcome regarding the canal area. The hon. Gentleman has reservations about, and has consistently raised, the cost of HS2, but it is on budget and on time. We must not forget that once HS2 is up and running, it will be the backbone of this country, bringing along with it 100,000 jobs.

Andy McDonald: The Secretary of State is supporting the sale of Network Rail’s property assets. The Federation of Small Businesses says that this will put small companies out of business because the new private owner will rapidly rack up rents, which will restrict key developments in places such as Chesterfield. Does he not see that the sell-off will lose the railway valuable and vitally important income?

John Bercow: Minister.

Come on!

Nusrat Ghani: I apologise hugely, Mr Speaker—I had a momentary lapse. I have no idea how to respond. Forgive me—I will take some direction from you.

John Bercow: Let us hear it again.

Andy McDonald: The Secretary of State is supporting the sale of Network Rail’s property assets. The Federation of Small Businesses says that this will put small companies out of business because the new private owner will rapidly rack up rents, which will restrict key developments in places such as Chesterfield. Does he not see that the sell-off will lose the railway valuable and vitally important income?

Nusrat Ghani: I thank the hon. Gentleman for repeating himself. The Secretary of State met the FSB yesterday and discussions on negotiations are ongoing.

Andy McDonald: In 2015, the DFT accepted Sir Peter Hendy’s plan to sell £1.8 billion of Network Rail property. These assets are now worth only £1 billion but generate £90 million of revenue each year. How can the Secretary of State still argue that this sell-off of the family silver makes sense? Is it not clear that his plan will cost Network Rail and British taxpayers dearly?

Nusrat Ghani: The Secretary of State will continue to realise assets when he can. We will then reinvest them in the railway network.

Regional Spending

Chi Onwurah: What steps he is taking to improve the equity of transport spending between regions.

Jo Johnson: Transport investment decisions are made based on a rigorous and fair appraisal process that ensures that spending goes where it is needed and delivers greatest value for money. Recent analysis by the Infrastructure and Projects Authority suggests that, in contrast to the five years leading up to 2010, planned central Government transport capital spending per head between 2017-18 and 2020-21 is expected to be higher in the north than in the south. That includes, as the hon. Lady will be pleased to learn, £337 million for new Tyne and Wear Metro rolling stock in her constituency.

Chi Onwurah: Since 2010, transport spending in London has been more than twice that in the whole of the north, and the Government’s own northern powerhouse says that underinvestment stops us exploiting strengths in manufacturing, energy, health and digital, which could transform the lives of my constituents. The Minister’s   own Transport for the North says that it will cost £27 billion to transform the north’s economy by taking advantage of those strengths: will he commit to funding it?

Jo Johnson: We are undertaking unprecedented investment in the north of England—£13 billion, which is the largest in Government history. Of course, we want to do more to ensure that we are building proper transport links and growing the northern powerhouse, which is why we have created Transport for the North and put it on a statutory footing. Over the recess, I was delighted to attend its very first board meeting as a statutory body.

David Linden: Instead of applying Barnett, why does the Minister not support his Department’s recommendation of £4.2 billion of funding for Scotland?

Jo Johnson: Scotland will receive significantly greater resources in the next control period between 2019 and 2024 than it has in any period in this country’s history.

Shipley: Eastern Bypass

Philip Davies: If his Department will fund an eastern bypass for Shipley.

Jesse Norman: Top o’ the morning to you, Mr Speaker. The Government have allocated significant resources to west Yorkshire for local transport schemes, including £781 million over 30 years from local growth funding and other sources, but Bradford Council has not yet brought forward that scheme for funding. Our consultation on the major roads network, which could provide another funding route for such schemes, has recently closed. We will respond to the consultation in due course.

Philip Davies: May I place on record my thanks to the Secretary of State for the interest he has shown in developing a Shipley eastern bypass, especially when he visited the area last year? That was in sharp contrast to Bradford Council, which has shown zero interest in developing such a bypass, despite it being much needed by local residents. The council has not even come up with the costs of development that the Secretary of State asked for more than four months ago. Will the Minister not only develop a bypass for Shipley, but bypass Bradford Council so that we can crack on with a scheme that is much needed by the local economy and residents?

Jesse Norman: As my hon. Friend says, this scheme potentially offers relief from congestion, better local access and better connectivity to Leeds-Bradford airport, and we are very interested to see it proceed.

Aircraft Noise: Heathrow

Ruth Cadbury: What plans his Department has to reduce the number of people affected by aircraft noise near Heathrow airport.

Adam Afriyie: What plans his Department has to reduce the number of people affected by aircraft noise near Heathrow airport.

Chris Grayling: The Government set noise controls at Heathrow airport, including total noise limits and aircraft movement limits for night flights. These controls, in conjunction with stricter aircraft noise standards negotiated by the UK at the international level, have resulted in a long-term reduction in the number of people affected by aircraft noise near the airport.

Ruth Cadbury: A freedom of information request revealed Government analysis that expects nearly a million households to face increased daytime noise if Heathrow is allowed to build a third runway. Will the Secretary of State visit my constituents, tens of thousands of whom will face significantly worse noise if the third runway goes ahead, and for whom no amount of noise insulation will be acceptable?

Chris Grayling: I have been in the hon. Lady’s constituency on many occasions and heard the noise there, and I am very pleased that, over the last 20 years, we have seen a steady reduction in aircraft noise. That is expected to continue as a new generation of aircraft appear in greater numbers. The projections show that, as we enter the 2030s with that change in aircraft fleet, we do not expect an overall noise impact on people around the airport. Nor do we expect an increase in the number of people within the 54 dB bracket, precisely because a new generation of lower-noise aircraft—they will also be lower-emission and lower-fuel consuming aircraft—will mean a quieter airport generally.

Adam Afriyie: The aviation national policy statement states that about 93,000 more people will be significantly affected by noise if the third runway goes ahead, yet Civil Aviation Authority figures indicate that more than 2 million people will be affected. Will the Government acknowledge that vast disparity in numbers, and will they update the aviation national policy statement?

Chris Grayling: Before the aviation national policy statement is brought to the House, it will be updated off the back of work done by the Transport Committee and the public consultations that have taken place—it will be a refreshed document when it comes before the House. The impact of noise on residents around Heathrow depends on an assessment of the rate of arrival of that new generation of aircraft. As we get into the 2030s, we expect no overall increase in the number of people in the 54 dB noise barrier because of the arrival of those new aircraft. There may be a short period in the mid-2020s when there is a small increase, depending on the airport’s rate of growth and the development of the aircraft fleet, but any such increase will be a short-term one.

Nick Smith: When will we get a new train service between Reading and Heathrow? That will help to reduce noise and get Welsh travellers to the airport.

Chris Grayling: Western rail access to Heathrow is part of our plans for control period 6, and I expect construction to start between 2019 and 2024. The hon.  Gentleman will be aware that I recently invited the private sector to bring forward proposals for southern access as well, as part of a land and surface access package that will bring substantial increases to the capacity of rail links to Heathrow airport.

Jeremy Quin: These problems are not unique to Heathrow; they also affect areas around Gatwick, which has a lower level of ambient noise. Will the Secretary of State assure the House that any further lessons learned about how we reduce noise at Heathrow can be applied more generally?

Chris Grayling: They can be, and the point I did not make in my response to the hon. Member for Brentford and Isleworth (Ruth Cadbury) and my hon. Friend the Member for Windsor (Adam Afriyie) is that we are in the process of modernising the use of airspace in this country. I hope and believe that that will allow us to manage much more carefully respite for airports, and flight paths into and out of airports, and to do the best we can to minimise the impact of aviation on communities. There can be no situation where there is no impact, but I want us to do our best to ensure that that impact is as carefully managed and minimised as possible.

Electric Vehicles: Public Charging Points

Wera Hobhouse: What steps he is taking to increase the number of public charging points for electric vehicles at commercial and industrial centres.

Jesse Norman: The UK is building one of the best global ChargePoint networks. Our new £400 million ChargePoint infrastructure investment fund will see thousands more charge points installed nationwide. We already provide grants to install charging stations in workplaces, homes and residential streets, and for buses and taxis. Through the Go Ultra Low city scheme, Bath—the hon. Lady’s constituency—and other cities are installing publicly accessible charging hubs. Also, the new Automated and Electric Vehicles Bill will encourage large fuel retailers to install charge points on their premises.

Wera Hobhouse: In Bath, the council is considering introducing a clean air zone, focusing particularly  on older, more polluting vehicles, but that will disproportionately disadvantage the less well-off, who are more likely to own older vehicles. Will the Government consider a scrappage scheme for old vehicles to encourage the uptake of electric vehicles without disadvantaging the less well-off in our city?

Jesse Norman: As the hon. Lady will be aware, substantial scrappage schemes already exist in the market through the private sector, and those look to continue.

Richard Burden: Expanding the charging infrastructure is a key part of encouraging people to switch to ultra-low emission vehicles, but does the Minister agree that the Government’s decision to cut the plug-in car grant and the home charging grant sends out contradictory signals? Will he commit to maintaining the current value of both grants in real terms, at least at their existing levels?

Jesse Norman: I am afraid I do not agree with the hon. Gentleman’s diagnosis of the situation. As I saw when I visited Nissan recently, electric cars are being taken up at higher rates than ever before, and the plug-in car grant has been an important part of that. As the industry becomes more mature—we are seeing greater signs of that; the new Nissan Leaf has started to have stable resale values, which is an important sign of maturity—we would naturally expect levels of Government subsidy to fall.

Kerry McCarthy: It is very welcome that the Government are looking at alternative fuels. Will the Minister agree to place in the House of Commons Library a summary of the grants, incentive payments and similar subsidies being paid out by his Department in respect of each of the different alternatives being explored?

Jesse Norman: As the hon. Lady will know, we have recently made a new £11 million investment in hydrogen charging, so she is absolutely right that we take a technology-neutral view and that we seek to encourage different forms of technology wherever available. I will certainly talk to officials about what information we can place in the Library, but I think much of it is already in the public domain.

Leaving the EU: Aviation Industry

Carol Monaghan: What recent discussions he has had with Cabinet colleagues on the future of the aviation industry after the UK leaves the EU.

Stuart McDonald: What recent discussions he has had with Cabinet colleagues on the future of the aviation industry after the UK leaves the EU.

Peter Grant: What recent discussions he has had with Cabinet colleagues on the future of the aviation industry after the UK leaves the EU.

Chris Grayling: I meet my right hon. Friends and Cabinet colleagues on a regular basis to discuss the UK’s exit from the EU. Ministers and officials across Departments are working closely to consider carefully the implications for the aviation sector after we leave the EU.

Carol Monaghan: Last month we heard that the first formal talks on a post-Brexit open skies deal with the US were cut short after US negotiators offered an inferior deal to the one we currently enjoy, so when does the Secretary of State plan to return to the negotiating table, and will he do so with a sense of reality about the impact that hard Brexit is having on the aviation industry?

Chris Grayling: The hon. Lady should not believe everything she reads in the papers. The discussions taking place between my Department and our counterparts in the United States have been cordial and have been going well. There are no issues that would act as an impediment towards a sensible post-Brexit agreement between the two countries.

Stuart McDonald: A key requirement in any deal with the US may well be that UK airlines are required to be UK majority owned, yet very few would be able to meet that standard. What are the realistic chances of the US ditching that long-standing policy for the sake of the UK?

Chris Grayling: Clearly, airline ownership is more complex as part of the European Union than it was in the pre-EU days, but nobody is seriously suggesting that we are not going to continue with the same kind of transatlantic partnerships we have at the moment. British Airways and American Airlines, for example, operate in lockstep with each other. We will progress in due time towards a sensible agreement that continues the extremely prosperous, important and successful transatlantic aviation routes.

Peter Grant: We have less than a year to sort this out. Already people who are attempting to book foreign holidays for next Easter, less than a year from now, are finding that they are having to accept a clause in the contract that waives any right to compensation if their holiday is cancelled because of problems with the lack of an open skies agreement. Is the Secretary of State trying to tell us that those reports from reputable travel agents are myths that we should not believe? Is it not a fact that the travel industry and the aviation industry understand how serious this problem is becoming and the Government, in their complacency, do not?

Chris Grayling: That is not accurate at all, as the hon. Gentleman will find if he listens to the chief executives of the International Airlines Group, EasyJet or a number of other airlines. I have had no airline, bar one, come to my desk and suggest that they are concerned about the situation. I think we know which the one is, and no other airline believes there is any likelihood of any impediment to aviation next year. Indeed, there will not be. Can you imagine, Mr Speaker, a situation where the Spanish, Italian, Portuguese or Greek Governments did not want holidaymakers to arrive from the United Kingdom in 2019? I have spoken to my counterparts and they snort with derision at the idea that the planes will not fly.

Thangam Debbonaire: Snorting with derision may be the response the Secretary of State has had, but people in my constituency who work in the aviation industry are really concerned about how we are going to function outwith the European Aviation Safety Agency. Will he please tell us a bit more about how we are going to function outwith the EASA?

Chris Grayling: The Civil Aviation Authority is making all preparations necessary if it needs to return to operating as a body in the form that it used to be in. However, it is the Government’s policy and our intent to remain part of EASA. There is no reason not to: countries inside and outside the European Union are part of it, and we supply a substantial proportion of its expertise. The leadership of EASA wants us to stay, and I am confident that, as we get through the process of negotiation, that is where we will end up.

Rail Freight

Kelvin Hopkins: What plans he has to increase the proportion of freight carried by rail.

Jo Johnson: In September 2016, the Government published a rail freight strategy setting out a vision for how the freight industry can grow. During control period 5, the Department is investing £235 million to improve the capacity of the network. Further funding for investment in the network will be available in control period 6.

Kelvin Hopkins: I thank the Minister for his answer, but is the reality not that only a small proportion of freight in Britain is carried by rail, and that it has been declining? By contrast, a third of all freight in Germany is transported by rail, and in the US the figure is 50%. To achieve a substantial modal shift in freight from road to rail, is it not essential to introduce a much bigger programme—a major programme—of investment in rail freight capacity starting very soon?

Jo Johnson: We share the hon. Gentleman’s ambition to support modal shift. The Government are always interested in hearing about ambitious schemes that would encourage that. As he will know, we recently launched a call for ideas for market-led proposals that will enhance the railway, and I encourage him to take part in that.

Layla Moran: Residents in north Oxford are gravely concerned about the increase in rail freight and particularly the possibility of the line being used to construct HS2. Children are already shaken out of their beds in the middle of the night because of freight trains. Will the Minister consent to meet me to discuss the concerns and, critically, the solutions, which include monitoring and speed reductions for the trains?

Jo Johnson: I obviously sympathise with the hon. Lady’s local residents. The Government are committed to getting freight off our roads and on to rail to realise the environmental and economic benefits of rail freight. However, the Department does not specify the level of freight services on the network, as that is a commercial matter for the freight operating companies and is a function of market demand. The Oxford area is essentially at capacity during the day, although the Oxford corridor capacity improvement scheme will deliver two additional freight train paths an hour in each direction. It is anticipated that rail will support the movement of construction materials for HS2, but it is not possible at this stage to determine where the freight services will operate. The maximum permissible speed that freight trains can travel at over sections of the network is a matter for Network Rail as the infrastructure manager.

Clive Betts: rose—

John Bercow: It is very good indeed to see the hon. Member for Sheffield South East (Mr Betts) back in his place.

Clive Betts: Thank you very much, Mr Speaker.

Midland Main Line: Rolling Stock

Clive Betts: What the timetable is for new rolling stock for midland main line to (a) be delivered and (b) enter service.

Jo Johnson: The Secretary of State’s ambition is for bi-modes to begin operating on the midland main line from 2021. No firm decision has yet been taken on rail services in the next east midlands franchise, which, as the hon. Gentleman will know, starts in August 2019.

Clive Betts: In the written statement that the Secretary of State made on 20 July, he promised, when cancelling electrification of the midland main line,
“a brand new fleet of bi-mode…trains from 2022”.—[Official Report, 20 July 2017; Vol. 627, c. 72WS.]
We seem to have gained a year somehow. The National Audit Office then said in a report from 29 March:
“In the case of Midland Main Line, bi-mode trains with the required speed and acceleration did not exist when the Secretary of State made his decision”,
and that the Department had informed him of that. I ask the Secretary of State or the Minister why the Secretary of State promised in his written statement to deliver bi-modal trains, which he knew not merely did not exist but had not even been developed. That is the situation. Why, at the time, did he not give the House the full facts instead of leading us to believe something that possibly was not true and was corrected only when the NAO produced its report?

Jo Johnson: Bi-mode trains capable of running at more than 120 mph in diesel mode are now in use on the Great Western main line. Bi-modes will soon be delivering better journeys on the east coast main line and transpennine routes as well.

Paul Blomfield: I am sorry, but that answer simply will not do. In relation to the midland main line, the NAO report reveals that at the time when the decision was made, the Secretary of State knew that bi-mode trains had “a poorer investment case” than electrification and would be worse polluters—actually, 25 times worse for carbon emissions. He also knew that the rolling stock required for that line—this is the crucial point in relation to the Minister’s response—would not exist, yet none of that information was in his statement to the House cancelling electrification. Does the Minister not accept that those were serious omissions?

Jo Johnson: On the contrary, equivalent trains to the ones that will be in service were already operational. As I have just said, bi-mode trains that are capable of running at more than 120 mph in diesel mode are already now in use on the Great Western main line.

Great Western Main Line: Electrification

Jonathan Edwards: What discussions he has had with the Prime Minister on the cancellation of the electrification of the Great Western main line between Cardiff and Swansea.

Chris Grayling: The Prime Minister and I discussed Cardiff to Swansea at the time, and reached the view that spending hundreds of millions of pounds of taxpayers’ money and causing massive disruption to passengers to enable the same  trains to travel on the same route at the same speed to the same timetable as they do today was not actually a sensible thing to do.

Jonathan Edwards: We know from press reports issued during the Easter break that the Prime Minister personally made the decision to renege on an election promise to electrify the main line to Swansea on the basis of cost. Is not the reality that the British Government do not consider the west of my country worthy of investment?

Chris Grayling: We made the decisions about electrification on the midland main line and the line between Cardiff and Swansea on the simple basis that spending hundreds of millions or billions of pounds to achieve the same journey times in the same trains was not sensible. The trains on the Great Western route are already in operation, delivering services to people in Swansea, for whom it is a great and important investment. Trains on the midland main line require the addition of one engine to provide a little bit of extra acceleration, but they already exist, and will be great for that line as well. So let us hear none of this nonsense from Opposition Members. In fact, during the years when they were in government, this was their policy: they believed that what was important was capacity and delivery, not electrification, and I agreed with them.

Rachael Maskell: Facts matter. In a written statement on 20 July last year, the Secretary of State said that with bi-mode trains it would be possible to
“achieve the same significant improvements to journeys”.—[Official Report, 20 July 2017; Vol. 627, c. 72WS.]
However, as we have heard from my hon. Friends the Members for Sheffield South East (Mr Betts) and for Sheffield Central (Paul Blomfield), it is clear from National Audit Office reports that that statement cannot be correct.

Michael Fabricant: Wrong question.

Rachael Maskell: No, this was about the Cardiff to Swansea route as well.
Why did the Secretary of State give those assurances? Now that he has come to the Dispatch Box, will he apologise?

Chris Grayling: Let us be clear. I stand by every word that I said then. We will deliver smart new trains and improved journey times for passengers on the midland main line, as we are currently doing and will continue to do on the Great Western main line, and as we will do on the east coast main line and the transpennine route. [Interruption.] As I have said, we will also deliver new trains providing better services for passengers on the midland main line. The only difference made by £1 billion of spending would be a one-minute saving in the journey time, and that is not good value for taxpayers’ money.

Barry Sheerman: On a point of order, Mr Speaker. Given that this is such an important matter, surely we should have a point of order on it.

John Bercow: As the hon. Gentleman will know on the strength of his nearly 39 years of experience in the  House, the effect of a point of order during exchanges on a question is to cause all further exchanges on it immediately to cease. Fortunately for the hon. Gentleman, he does not risk becoming hugely unpopular as a result of his attempted point of order, for the simple reason that no one else was standing and seeking to catch my eye—other than the hon. Gentleman with his rather bogus, albeit enjoyable, point of order.

Rail Reform

Luke Hall: What his policy is on rail reform.

Jo Johnson: The Secretary of State’s strategic vision for rail was published in November 2017, and sets out our key reforms. Better teamwork between franchise operators and Network Rail will make the railway more responsive to customers’ needs and move power closer to local areas.

Luke Hall: South Gloucestershire Council is pushing ahead with its plans to deliver a vital half-hourly train link from Yate to Bristol. Will my hon. Friend explain how his rail policies will help to achieve that, and will he consider visiting Yate so that he can see at first hand how important the upgrade is to our local community?

Jo Johnson: Improving connectivity around our great cities, including Bristol, is exactly the kind of scheme that our reforms are designed to deliver. The Government will continue to work closely with local partners to deliver the MetroWest scheme in the Bristol area. We are also examining the potential for the new MetroWest services to be extended beyond their currently planned termini.

Martin Whitfield: Tarmac’s Dunbar cement plant in East Lothian transports substantial amounts of its product down the east coast main line to London to fuel the construction industry here. What steps is the Minister taking, as part of his plan, to facilitate better engagement between passengers, rail freight users and Network Rail commuters?

Jo Johnson: That is an important subject, which we hope the new east coast partnership will help to address.

Bob Neill: rose—

John Bercow: Order. I know the whole House will want to join me in congratulating the hon. Member for Bromley and Chislehurst (Robert Neill) on his engagement to Ann-Louise Whittaker, and may I say to the hon. Gentleman that, notwithstanding the fact that he is a very young man to be planning to rush into matrimony, we all wish him and Ann-Louise a very happy wedding on Friday 27 July?

Bob Neill: That is very kind, Mr Speaker; Ann-Louise and I are very grateful to you.

South-east London Metro Routes

Bob Neill: What assessment he has made of the reliability of rail services on metro routes in south-east London.

Jo Johnson: I echo your good wishes to my hon. Friend, Mr Speaker.
All train operators must deliver the performance benchmarks set out in the franchise agreements that cover all their passenger services. In respect of Southeastern’s metro service, its public performance measure has improved from 87% to nearly 89% over the past year.

Bob Neill: Is the Minister not concerned, first, that many of the regular commuters on our line do not regard the performance measures as reflecting reality, particularly in the rush hour, and, secondly, that Network Rail only a couple of days ago published a suggestion that performance will actually deteriorate over the next coming years and will not pick up again until 2024? I would like our wedding guests to come on the train, but I do not think I can advise them to do so at the moment; does the Minister agree that the situation is wholly unacceptable, and what will he do about it?

John Bercow: Before 27 July.

Jo Johnson: We are working closely with Network Rail to ensure punctual and reliable services on the network. We are ensuring it is doing everything it possibly can to maintain and build upon the current improving levels of performance. My hon. Friend mentioned the performance targets: the operator will be required as part of the next franchise arrangements to publish on its website in relation to each reporting period its performance against the following metrics: cancellation figures, short formation figures, and now, critically, timing to three minutes, rather than the previous performance targets.

Clive Efford: Mr Speaker, may I associate myself and my hon. Friends with your kind words to my constituency neighbour, the hon. Member for Bromley and Chislehurst (Robert Neill), and wish him all the best?
When I arrived at my station this morning, they were handing out free copies of fiction: the Southeastern rail timetable. It is fiction because of not just the performance of Southeastern, but the poor infrastructure that we have to endure. We have spent £1 billion upgrading London Bridge, and it is a magnificent project, but unfortunately we have seen broken rails and the breakdown of signals last week and the week before, and there was another stranded train outside St Johns station on 5 April. This is not good enough: we need to upgrade the infrastructure around London Bridge, otherwise all the money will have been wasted.

Jo Johnson: In the next franchise period we will ensure that performance in quality is an absolute focus for the new operator. When that is in place moving towards next year, the new franchisee will adopt the new measures we have proposed as part of the move towards control period 6. The use of a public performance  measure that allows services to arrive up to five minutes late at end destination will be replaced by timed to three, or T3, and that measure will be used for the services along this route.

Matthew Pennycook: Like my colleague, my hon. Friend the Member for Eltham (Clive Efford), I wish the hon. Member for Bromley and Chislehurst (Robert Neill) all the best.
After years of disruption due to the London Bridge rebuild, passengers discovered last week that Greenwich line evening services will not be of the frequency previously advertised after May because, according to Southeastern, it does not have enough drivers. Can Ministers do anything about this frankly risible situation?

Jo Johnson: I thank the hon. Gentleman for bringing that concern to my attention, and I will discuss it with Southeastern.

Fitness to Drive

Kevin Foster: What assessment he has made of the effectiveness of medical requirements for holding a driving licence in ensuring that drivers are fit to drive.

Jesse Norman: The current driver licensing arrangements take into account the risks that an individual poses to road safety and are designed to be fair and proportionate to all drivers who remain fit and competent to drive, regardless of age. The Driver and Vehicle Licensing Agency keeps all its medical driver licensing policy and processes under review.

Kevin Foster: The Minister will be aware that the current system of car driving licence renewal includes no requirement at all for independent medical evidence to ensure that a driver’s health or eyesight meet the legal requirements. Does he agree that this self-certification process is inadequate and open to abuse, and will he agree to review it?

Jesse Norman: There is no evidence—certainly none that we are aware of or that has been brought to our attention—to suggest that requiring independent medical evidence in relation to a driver’s health or eyesight would lead to an improvement in road safety. The current process is balanced and proportionate, and focuses resources on drivers who need medical investigation. Those drivers—in fact, all drivers—are legally obliged to notify the DVLA if they develop a medical condition that could affect their ability to drive safely. Where a driver has failed to do so, the DVLA will investigate notifications from concerned friends, relatives, the police or medical professionals.

Dualling of the A45: Stanwick to Thrapston

Tom Pursglove: What steps his Department has taken to conduct an environmental study of the dualling of the A45 between Stanwick and Thrapston.

Jesse Norman: The road investment strategy announced the Government’s intention to develop a scheme to   upgrade the A45 between Stanwick and Thrapston to a full dual carriageway. The scheme is at an early stage of development and a preliminary environmental study will be carried out as part of this development work.

Tom Pursglove: This dualling is something that I have campaigned particularly hard for. It has the overwhelming support of local people and would do much to improve the strategically important link between the A14 and the M1. The environmental study is key to progress, so will the Minister join me in pushing for that work to be carried out as soon as possible?

Jesse Norman: My hon. Friend has been a tireless and energetic campaigner on this issue, as on so many others, and I can assure him that the environmental study will be one of the first items to be completed under the options assessment work.

HS2: Extension to Scotland

Paul Sweeney: What assessment he has made of the potential merits of extending High Speed 2 to Scotland.

Nusrat Ghani: From the day phase 1 opens, HS2 trains will run directly to Scotland, with journey times of less than four hours between London and Glasgow. When the full Y network opens, HS2 will serve both Glasgow and Edinburgh in three hours 40 minutes to London. The Department for Transport is working closely with Transport Scotland and Network Rail to look at further options that might have a good business case, working towards the UK and Scottish Governments’ shared ultimate ambition of a three-hour journey time between London and Scotland.

Paul Sweeney: Will the Minister guarantee that, once HS2 is fully constructed, the journey time between Glasgow and Manchester will not be any longer than it is currently?

Nusrat Ghani: We have no reason to expect increases in journey times between Glasgow and Manchester as a result of HS2.

Rail Sleeper Services: Scotland to England

Jamie Stone: What steps his Department is taking to support the provision of sleeper rail services between Scotland and England.

Nusrat Ghani: In his autumn statement of 2011, the Chancellor announced a commitment to contribute £50 million towards the cost of improving and upgrading the Caledonian sleeper service, including rolling stock and infrastructure improvements. We understand that new rolling stock will start to be introduced in the autumn. Under the devolved arrangements relating to the railways in Scotland, the Caledonian sleeper service is the responsibility of the Scottish Government and operates under a franchise procured by Scottish Ministers.

Jamie Stone: The northern sleeper service is good for the environment, stress-free, fun and actually rather romantic. Does the Minister agree that further development would do much to boost tourism in the highlands and in my constituency?

Nusrat Ghani: We do like romance, and the new trains will offer improved facilities, comfort, hospitality and security for passengers. Passengers’ experience will be enhanced, supported by improved ticketing, booking channels and information, station improvements and support for post-travel arrangements. Staying on the theme of romance, I know that the hon. Gentleman has a particular interest in disability and access, for which these trains will be suitable, as he has a close family member with disability issues.

John Bercow: That sounds like a very agreeable adventure to me. I must obviously add it to my bucket list.

HS2: Phase 2b

Graham Stringer: What steps he has taken to implement phase 2b of High Speed 2.

Nusrat Ghani: In November 2016, the Government confirmed the majority of the HS2 phase 2b route and launched a consultation on seven route refinements. The Government made a decision on the phase 2b route in July 2017. To deposit the phase 2b hybrid Bill in 2019, HS2 Ltd is developing designs for the working draft environmental statement. The Government have provided funding for growth strategies to HS2 places, enabling the plans to be HS2-ready.

Graham Stringer: Can the Minister assure the House that the hybrid Bill for HS2 phase 2b will take precedence over Crossrail 2?

Nusrat Ghani: Consideration of the hybrid Bill will take place when it is due to take place in Parliament. It is interesting to note that we have had a lot of support from Members across the House; it would be nice for that support to be reflected when the Bill comes to the House, with all Members voting to support it rather than abstaining.

Eddie Hughes: We seem to have a lot of jobs created by HS2 in the midlands. How many have been created so far?

Nusrat Ghani: My hon. Friend is a passionate campaigner for the midlands and any opportunity I have to talk proudly about Birmingham in particular, is welcome. Over its course, HS2 will create 100,000 jobs. It is important to note that the majority of those jobs will be created outside London, so opportunities will be vast along the line.

Channel Fixed Link

Patrick Grady: What discussions he has had with the Secretary of State for Foreign and Commonwealth Affairs and with his French counterpart on constructing a fixed link across the Channel.

Jo Johnson: The Secretary of State and I have periodic discussions with our counterparts in our partner countries on a range of issues.

Patrick Grady: Well, can the Minister tell us, then, whether, as the question says, those discussions have included the concept of a new fixed link? The Foreign Secretary seems to think that it is a very good idea, but I am not clear whether anyone else in the Government or the Cabinet does.

Jo Johnson: This is certainly an idea worth exploring. I repeat that this is a view shared not just in this Government but in the French Government. The hon. Gentleman will recall that at the conclusion of the highly successful Anglo-French summit it was agreed that there would be a committee of wise people, a comité des sages, established to consider reviving the tradition of UK-French collaboration on a range of matters, including infrastructure projects.

John Bercow: Well, I would call the hon. Member for Bassetlaw (John Mann) if he were here, but he isn’t, so I won’t.

Topical Questions

Maggie Throup: If he will make a statement on his departmental responsibilities.

Chris Grayling: We spend a lot of time talking about planes, trains and automobiles in these sessions, but we do not spend much time talking about ships. I want to pay tribute to all those involved in the talks that took place in London last week, particularly those from my Department. They paved the way for an historic agreement in the maritime sector on cutting carbon emissions from shipping. It is a really important step forward and I commend all those involved.

Maggie Throup: Will the Secretary of State visit Long Eaton as a matter of urgency to visit those property owners directly affected by HS2, some of whom are facing the prospect of being tens of thousands of pounds out of pocket? Will he reaffirm his commitment to the House today that no one will lose out as a result of HS2?

Chris Grayling: I know that we have particular issues with some of the properties in Long Eaton, particularly the railway cottages. I have worked and will continue to work closely with my hon. Friend to ensure that HS2 does the right thing by those people.

Alan Brown: On “Question Time”, the Secretary of State intimated that, post Brexit, trucks will not be checked and will move freely through the border, as happens in Canada and the US. I have an official document that confirms that all lorries are stopped on the US-Canada border. Will he apologise for giving out duff information, do his homework and tell the House what the concrete plans will be post Brexit?

Chris Grayling: As I have said before—I say it again today—there will not be physical checks that require every lorry to be stopped at Dover. It is not physically possible to do it, and in today’s world of trusted trader systems and electronic processing of customs information, there is no need for that to happen. I would also say that we are confident that we will deliver, as is our intention, a sensible free trade agreement with the European Union that will make all this an irrelevant discussion.

Damien Moore: Following the delays to electrification, Arriva has announced a new timetable downgrading the train service between my constituency of Southport and south Manchester, which will have significant consequences for Southport’s residents and its local economy. What reassurances can my right hon. Friend provide to my constituents and rail passengers along that line who are now having to make difficult choices about where they live and work as a result of this downgrading?

Chris Grayling: My hon. Friend knows that I have been to Southport and talked to some of those affected. As a result of those recent discussions, we have been able to put back in two extra services to Manchester Piccadilly. Of course, the original franchise plan was for the services to go to Manchester Victoria, but I have listened carefully to what has been said. Timetable changes cannot happen quickly and easily, but I will do my best to work with my hon. Friend to ensure that there is a better mix of services for the future.

Matt Rodda: With free bus travel for the under-25s estimated at £1.4 billion a year, why is the Minister opposing a scheme that could benefit up to 13 million young people, saving them up to £1,000 each a year, at a time when they face significant financial hardship due to tuition fees and the high cost of living?

Nusrat Ghani: This was an intriguing policy proposed by Labour at the Budget, and the figures did not seem to add up. At one point Labour was saying it would cost just over £1 billion, but it looks like it might cost closer to £13 billion. The hon. Gentleman needs to go back to school and add up his figures. We already provide £1 billion towards concessionary travel to support up to 10 million older people, and disabled people, too. I would be intrigued to know whether Labour has budgeted for this concessionary travel to be before or after 9.30 am.

Matt Rodda: Can the Minister explain how she has calculated that figure of £13 billion? Research by University College London, which is widely accepted across the sector, shows that every individual person in the UK could be given free bus travel for £5 billion.

Nusrat Ghani: The figures have already changed from around £1 billion to the projected figure of over £13 billion, and now to £5 billion. When the shadow Minister makes proposals, and if he wants not only the sector but young people to take them seriously, I suggest that he comes to the Dispatch Box with the most accurate figure that comes to hand. We are doing what we can to support bus patronage, including enabling local authorities   to work with bus providers to make sure that people can make the most requested journeys. I must add that we already provide over £1 billion-worth of concessionary travel to older people and to those with disabilities, and perhaps we could take Labour’s proposal more seriously if the figures added up.

Eddie Hughes: Is the Department doing anything to monitor the effective spending of the additional money being given to councils to fix potholes, including the £262,000 that was given to Walsall Council?

Jesse Norman: That is a great question. As my hon. Friend will know, the pothole action fund is part of a £6 billion fund we are spending on local highways between 2015 and 2021, including £105 million for highways maintenance in the West Midlands combined authority, which includes Walsall. We ask that highways authorities provide a statement on their websites on how they utilise the pothole action fund money they have been allocated and, of course, we review and assess how that money is spent. We are always looking for, and seeking to incentivise, best practice.

Kerry McCarthy: Bristol City Council is considering five different options for clean air zones. Air pollution is estimated to kill 300 people a year in the city. What is the Minister doing to help councils to deliver on tackling air pollution?

Jesse Norman: As the hon. Lady will know, we have spent more money than any Government have ever spent in this country on tackling air quality issues. We are working very closely with local authorities, including Bristol, to do that. Something like £400 million is already in prospect to support local authorities in this regard, and we look forward to seeing further action by Bristol and other local authorities to support it.

Theresa Villiers: I was alarmed to learn that Govia Thameslink Railway is planning to cut Great Northern services at Oakleigh Park station in the morning peak. GTR has promised me it will restore the services when new rolling stock is introduced this year. Will the Minister work with me to hold it to that promise?

Jo Johnson: I would be delighted to work with my right hon. Friend to address the issue she raises.

Ian Lucas: Volunteer drivers in Wrexham, through wonderful charities like Dynamic and Chariotts, are very concerned about the impact of possible regulatory change, which may affect their ability to provide a vital service. Can the Minister reassure me that the position of volunteer drivers will not be affected by new changes?

Jesse Norman: As the hon. Gentleman notes, we are in the process of seeking to apply EU law as it applies  to community transport. We have launched a review to explore several specific workarounds that address the concerns that community transport operators may have.  We look forward to the completion of that review, and we will be publishing our own thoughts as a result, based on the substantial input we have gathered.

Martin Vickers: The bioethanol industry and the farming community that supplies it are looking for some certainty about the introduction of E10. Is the Minister able to give a clear steer as to when they can expect that certainty and whether the Government will be giving support?

Jesse Norman: My hon. Friend will be aware that the Government have taken a very important forward position by introducing the renewable transport fuel obligation. We are looking closely at E10, and at international precedents and examples as to how enhanced ethanol fuels have been brought into play. It is important to respect market dynamics, so this is a slightly tricky issue, on which we are spending some time and consideration.

Paul Sweeney: There is mounting concern on the Clyde that an active programme is being undertaken by Peel Ports, which owns both the Clydeport authority and the Mersey Docks and Harbour Company, to plough billions of pounds of investment into Merseyside at the expense of the Clyde, stifling investment in the Clyde’s port facilities. Will the Minister undertake an immediate investigation into anti-competitive practices in both of the UK’s two main west coast ports, as this is unacceptable?

Nusrat Ghani: The hon. Gentleman raises an important issue. I am glad he has brought it to my attention and I am more than happy to have a meeting with him to discuss it further.

Bob Neill: Yesterday, my hon. Friend—my very good friend—the Minister of State responded to an Adjournment debate on impacts of the timetable changes of the Thameslink programme. He said that Members were welcome to suggest changes where there had been negative impacts. May I suggest to him that the reduction in services from Orpington to Victoria via Bromley South is precisely such a negative change, which should be looked at urgently?

Jo Johnson: I thank my hon. Friend for his question. Of course, that matter is close to my heart and I will be paying extraordinary attention to it in the coming months.

Stuart McDonald: Will the Minister tell us what recent research the Department has undertaken on whether shared space schemes without kerbs or controlled crossings are safe for people with vision impairments?

Nusrat Ghani: We have been reviewing our accessibility plan within the Department and will be reviewing how we deal with shared spaces. The hon. Gentleman knows that I used to chair the all-party group on eye health and visual impairment, which has huge concerns about shared spaces. We will be making a statement on this shortly. We want to make sure that all of our spaces, especially those around transport infrastructure, are accessible for people with all disabilities.

Fiona Bruce: Reopening Middlewich railway station to passengers is a matter of crucial importance to many of my constituents. What progress is being made on developing the business case for that?

Jo Johnson: I know there is strong local support for improvements to the rail network in Cheshire. I am pleased to confirm that the Cheshire and Warrington local enterprise partnership is in the process of establishing a working group with local authority partners and Network Rail to examine the feasibility of reopening the mid-Cheshire link railway line, including Middlewich station, in my hon. Friend’s constituency, and that the Department has offered to provide advice.

Daniel Zeichner: A few weeks ago, we had the 10th anniversary of the introduction of the free bus pass scheme for pensioners, which is a hugely popular policy. What efforts did the Department make to mark that anniversary? What assurances can the Minister give pensioners about the future of the scheme?

Nusrat Ghani: The bus pass scheme tends to be reviewed every five years, and what we have been able to do is ensure that that review does not take place every five years and that the concessionary bus pass remains in place for as long as is needed.

Matt Warman: The Secretary of State has long taken a personal interest in the Boston bypass. Will he join me in commending the excellent campaign being run by my local paper, the Boston Standard, which is gathering evidence from local hauliers, in particular? Does he agree that it bolsters an already compelling case for an application to be made to his bypass fund for this road in due course?

Chris Grayling: As my hon. Friend knows, I have visited the proposed site of the Boston bypass on more than one occasion over the years. I know that a vigorous campaign has been run by his local paper, local activists and himself. You will know, Mr Speaker, that we will shortly be bringing forward the next stage of our proposals for what I have dubbed the “bypass fund”, and there will be opportunities to build bypasses in the not-too-distant future.

Dan Carden: Evidence shows that regulating bus services can improve the service and boost passenger numbers, so why are this Government siding with bus companies, rather than bus passengers, by refusing councils the powers to take back control of local buses?

Nusrat Ghani: I am a bit confused as to where the hon. Gentleman read that, because we have not refused any authorities. We are trying to help local authorities to manage their bus services and work with bus operators to deliver the best service that they think is needed at local level. The decision is best made locally. On top of that, we have spent £250 million to support bus services in England via the bus service operators grant, and £40 million of that goes towards supporting concessionary travel at a local level.

Michael Fabricant: My right hon. Friend the Secretary of State is a renowned blue-sky thinker, so does he imagine that any time soon, or even some day in the future, people will be able to get on an HS2 train in Manchester or Glasgow and go non-stop to the European continent?

Chris Grayling: For a moment, I thought my hon. Friend was going to ask me whether people would be able to get on an HS2 train in Manchester and travel to Lichfield. Of course, it always depends on the market. When the first trains started to operate through the channel tunnel, a fleet of trains was bought to provide links from the north of England through to the continent, but the market was never there—although one never says never.

Karin Smyth: The Hussey family and I are grateful for the Minister’s support following Freddie’s tragic death in 2014, and we will welcome him to Bristol next week for a trailer safety summit. On Tuesday, the other place agreed to improve trailer safety measures; is the Minister willing to share his view of their lordships’ decision?

Jesse Norman: I have greatly enjoyed the chance to work with the hon. Lady on the issues that she describes, and I am very much looking forward to attending her trailer safety summit next week. The Haulage Permits and Trailer Registration Bill will come to this House in due course, so we will then have a chance to look at what their lordships have said.

Points of Order

Andy McDonald: On a point of order, Mr Speaker. We discussed in Transport questions the cancellation of line electrification throughout the country. The Secretary of State said in the recess last summer that the bi-mode alternatives could achieve the same significant improvements to journeys. The National Audit Office, on which we rely—it is not Opposition Members saying this—has said that
“bi-mode trains with the required speed and acceleration”
to meet the timetable
“did not exist”.
The Secretary of State has had the opportunity today to correct the position. The two statements are mutually exclusive and he cannot maintain that position. It is important that Ministers of the Crown come to the Dispatch Box and say things that are grounded in fact. There is a danger, however inadvertent, that the House has been misled about these trains’ ability to deliver, as my hon. Friends have pointed out repeatedly, yet the Secretary of State will not take the opportunity to clarify the position. I seek your advice as to how that clarification might be achieved, Mr Speaker.

John Bercow: The Secretary of State is now poised, like a panther ready to pounce, so the hon. Gentleman may have secured, if not pre-empted, at any rate, early gratification, in that the Secretary of State is marching towards the Dispatch Box.

Chris Grayling: Further to that point of order, Mr Speaker. It is self-evident that last January, when we discussed these issues, the trains that will run on the midland main line had not been ordered and therefore did not exist. As things stand today—as things stood last summer and last April—there are already 120 mph-plus bi-mode trains operating on the great western main line. I have manufacturers beating a path to my door to build the trains for the midland main line; of course they are going to run.

John Bercow: What I would say to the shadow Secretary of State is that he has made his point with force and alacrity, it is on the record, and the Secretary of State has responded in a similar vein. This dispute—it is a genuine dispute about what the facts are—can and doubtless will continue, but by means other than the point of order procedure. I hope that honour is served.

Bill Cash: rose—

John Bercow: Just as I am about to proceed to the next business, I see leaping to his feet, with his characteristic energy and suppleness, the young representative from Stone, Sir William Cash.

Bill Cash: On a point of order, Mr Speaker. Do you regard the outrageous abuse and intimidation that has been levelled against the hon. Members for Stoke-on-Trent North (Ruth Smeeth), for Liverpool, Wavertree (Luciana Berger) and others as sufficient evidence of a contempt of the House? Page 262 of “Erskine May” states that it is a contempt of the House to molest and intimidate MPs by abusive language outside or inside the precincts of the House. Is there a prima facie case for contempt in the circumstances that I have described, with this completely and totally outrageous behaviour by members of the public towards those Members?

John Bercow: I am grateful to the hon. Gentleman for his point of order, which I treat extremely seriously. I do so partly because of the content and partly in deference to his renowned parliamentarianism. The short answer is that there could be such a case. The particulars would have to be studied and it would be imprudent, and therefore inappropriate, for me to seek to venture a judgment here and now. However, as he will know, if there is an allegation of contempt to be made, it should properly be made in writing to me and I will then reflect on it, taking such professional advice as I think I need, but I thank him for raising this point of order, which I know he does out of a concern to protect the rights of Members in all parts of the House. Any Member could be similarly affected, and he has done a public service. Knowing his dogged tenacity and his insistence on following through, I imagine that his letter will be winging its way to me ere long.

Business of the House

Valerie Vaz: Will the Leader of the House please give us the forthcoming business?

Andrea Leadsom: The business for next week will include:
Monday 23 April—Second Reading of the Rating (Property in Common Occupation) and Council Tax (Empty Dwellings) Bill followed by motion relating to a statutory instrument on the Higher Education and Research Act 2017.
Tuesday 24 April—Remaining stages of the Financial Guidance and Claims Bill [Lords] followed by motion to approve a money resolution relating to the Mental Health Units (Use of Force) Bill.
Wednesday 25 April—Opposition day (9th allotted day). There will be a debate on schools followed by a debate on social care. Both debates will arise on an Opposition motion. Followed by debate on a motion on section 5 of the European Communities (Amendment) Act 1993.
Thursday 26 April—Debate on a motion on customs and borders followed by debate on a motion on plastic bottles and coffee cups. The subjects for these debates were determined by the Backbench Business Committee.
Friday 27 April—Private Members’ Bills.
The provisional business for the week commencing 30 April will include:
Monday 30 April—Remaining stages of the Domestic Gas and Electricity (Tariff Cap) Bill followed by consideration in Committee and remaining stages of the Laser Misuse (Vehicles) Bill [Lords].
This has been a key week for Parliament. The Prime Minister took part in more than nine hours of debate on Syria, and with the Report stage of the European Union (Withdrawal) Bill under way in the other place, we continue to shape our future outside the European Union. Members across both Houses have held Government to account, scrutinised decisions and debated matters of national and global importance, putting the vital role of Parliament beyond any doubt.
It has been our privilege to host the Commonwealth Heads of Government meeting this week, and I have personally enjoyed the opportunity to meet delegates from around the world. I want to thank them for the generosity of time and spirit that they have shown.
Finally, we send our best wishes to another place with which we have strong ties: Israel marks the 70th anniversary of its independence day today. This week’s hugely important debate on anti-Semitism has shown that we must continue to uphold the British tradition of freedom of religion. To all those celebrating, I wish them a very happy day.

Valerie Vaz: I thank the Leader of the House for the forthcoming business. I also thank her for Monday’s motion relating to the statutory instrument on higher education, Tuesday’s motion to approve the money resolution—my hon. Friend the Member for Croydon North (Mr Reed) will be delighted, because the business was cancelled again earlier this week—and for our Opposition day.
This seems a bit churlish, but we do need to have the Report stage of the Data Protection Bill, we are still waiting for the nurses bursaries statutory instrument and the Criminal Legal Aid (Remuneration) (Amendment) Regulations 2018 need to be revoked and relaid, because we are running out of time.
I, too, welcome the Commonwealth Heads of Government here to the 25th summit. They will know that a speech given to the Conservative association in Birmingham 50 years ago by a former Member of the House, Enoch Powell, was in response to immigration from the Commonwealth and the proposed Race Relations Bill. I remember my parents being alarmed at the speech—broadcasting it again was unnecessary—but they and other visible minorities were somewhat reassured by the stance of the then Prime Minister, the great reforming Labour Prime Minister, Harold Wilson, who, despite those inflammatory words, passed the Race Relations Act 1968.
It was chilling, therefore, when my right hon. Friend the Member for Tottenham (Mr Lammy) had to ask for—and was granted it by you, Mr Speaker—an urgent question on the unjust treatment of British citizens who came from Commonwealth countries; I and 134 other Members across the House signed the letter to the Prime Minister. The Home Secretary said it was wrong and appalling, but came to the House only in response to the UQ. British citizens now in their 60s and 70s are losing the right to work, rent property, receive their pensions and access their bank accounts and vital healthcare, and some have even been deported. These cases can be dealt with immediately.
The presumption should be that those people are here legally, not illegally. The destruction or shredding of landing cards is a distraction. It is only as a result of 2014 Government policy that evidence is required, and landing cards are only one form of such evidence; there are others, including tax returns, national insurance numbers and NHS numbers. Can we, therefore, have a statement next week so that the Home Secretary can tell the House what she appeared not to know earlier this week—how many people are affected, how many have been deported, how many are in detention centres? My right hon. Friend the shadow Home Secretary met a woman in Yarl’s Wood whose parents were both British citizens. Why do we not know these figures? The Home Office has no direction—it is Rudderless. The Secretary of State and Ministers have to direct what a Department does. That is why the series was called “Yes, Minister”—because Ministers have the civil servants who respond to what they want.
I want to highlight another injustice—that affecting students in receipt of disabled students’ allowances. With changes to DSA, a £200 up-front fee was applied across the board and not means-tested, which has resulted in a nearly 30% reduction in the number of students taking up vital equipment that could help them to work independently. Some 20% of students at the Royal Agricultural University are in receipt of DSA. We need their skills, so we need them to qualify, particularly because, as the Leader of the House said, we are leaving the EU. Can we have a debate, therefore, so that the Government can look again at removing that £200 up-front fee?
The Backbench Business Committee, not the Government, agreed to a debate on customs and borders. Opposition analysis shows that 44% of Brexit legislation  is still to be introduced: Bills on immigration, fisheries, and the withdrawal agreement and implementation. Last June, the Prime Minister said that this Parliament would have a busy legislative Session, but the Government have passed only four Bills since the last Queen’s Speech and not a single piece of Brexit legislation. Given that 11 Bills will have to go through the House before the end of the transition period, will the Leader of the House publish a timetable or a grid like that produced by the Institute for Government, and will she confirm whether the EU withdrawal Bill—which is being considered by the other place, where Members have agreed they want to be in a customs union—will come before this House in the week commencing 21 May?
I know that the Government do not like to come to Parliament, but I was a bit saddened to read in The House magazine—we like The House magazine, particularly when we are in it, although in my case that is not very often—an article on restoration and renewal. The right approach would have been to make that statement to this Chamber, given that so many Members on both sides took part in the debate and were concerned about it. I know that some decisions are already in train, and it would have been appropriate to come to the House.
I recently had to take part in a rally in opposition to the English Defence League. For the very first time, it was allowed to assemble right next to our peace and unity rally near St Paul’s at the Crossing in Walsall. I now have to write three letters to ascertain who was responsible for that decision—and there were breaches of the peace. In the evening, I heard the testimony of Janine Webber, a child of the holocaust. She told us that her grandmother, father and mother were murdered, and she said that when they took her brother away, she wondered why they let her go. She would have been saddened by what happened, but proud at the debate—at the dignity of all our colleagues who took part and at how they have opposed anti-Semitism. I hope that the time comes when we judge each other not on the colour of our skin, not on our religion and not on our gender, but just on who we are.
Finally, on a slightly happier note, I wish the Chair of the Backbench Business Committee, my hon. Friend the Member for Gateshead (Ian Mearns), a very happy birthday on Saturday—a birthday he shares with Her Majesty.

Ian Mearns: Every year.

Valerie Vaz: Every year. I wish Her Majesty a happy birthday, and we thank her for her service to the country and to the Commonwealth.

Andrea Leadsom: I join the hon. Lady in wishing the Chairman of the Backbench Business Committee and Her Majesty very happy birthdays for Saturday. I take it that the hon. Gentleman is slightly younger than Her Majesty, but I am sure he would not venture to suggest by how much.
The hon. Lady has raised a number of important points. I am glad she is glad that we have debates on the higher education statutory instrument, the money resolution and Opposition motions scheduled for next week. We are, in fact, extraordinarily busy, and I would like to remind her of some of the achievements so far. We have introduced 27 Bills in this Session so far, including the seminal European Union (Withdrawal) Bill and other  very important legislation that she mentioned, such as that on the general data protection regulation—I assure her that we are very aware of the impending deadline, and proceedings will be brought forward very soon.
We have had 11 Bills sent for Royal Assent already, including the Space Industry Bill—a fantastic opportunity to build the new skilled jobs of the future. We have six Brexit Bills before Parliament at the moment—the withdrawal Bill and Bills on nuclear safeguards, customs, trade, sanctions and road haulage. Of course, hundreds of statutory instruments have also been passed by each House. In addition, we have seven draft Bills published in this Session, and I will not detain the House any longer by naming them all.
However, I want to make the point to the hon. Lady that, in fact, we are achieving a lot, and I am delighted that that is the case. I am also delighted that the House is taking such an active part in not only the legislative programme, but some of the vital debates we have had just this week—that is incredibly important.
On the Windrush generation, which the hon. Lady raised, I can only again apologise. These individuals are British; they have absolutely every right to be here. What has happened is incredibly regrettable. My right hon. Friends the Prime Minister and the Home Secretary have apologised without reservation, and I do so again today. The Home Office is determined to put this right in short order, and that is what it is absolutely focused on doing.
The hon. Lady raised the issue of a fee, which I am sorry to say I am not aware of. If I may, I will investigate and come back to her. She asked when the EU withdrawal Bill will come back. As she knows, there are no programme motions, so their lordships will send it back to us in due course. Of course, we will consider all attempts to improve legislation, as we always do, and we will respond in due course to amendments that have been passed in the other place.
The hon. Lady also raised the issue of the restoration and renewal of the Palace. I am sorry if she thinks there was some sort of statement. In fact, the article in The House magazine was merely an attempt to keep Members’ interest in the subject. I am, of course, delighted to talk to her about progress at any time. As soon as there is substantive progress—for example, once we have recruited the internal and external members for the shadow sponsor body—there will be the opportunity to debate that in this place.
Finally, I pay tribute to the hon. Lady’s constituent, Janine Webber. It sounds as if that was harrowing testimony, and I am sure all of us in the House absolutely support the hon. Lady’s view that we should consider each other for who we are, not for where we come from or what we believe in.

Christopher Chope: May I ask my right hon. Friend about two statutory instruments that were laid just before Easter, which are designed to abolish Christchurch Borough Council against its will? Will she assure me that neither of those instruments will be brought forward for debate until there has been a report from the Joint Committee on Statutory Instruments, to which I have written pointing out that one of those statutory instruments seeks to change primary legislation and to do so retrospectively, with hybrid effect and in breach of Government undertakings to Parliament?

Andrea Leadsom: My hon. Friend raises a serious matter, although it is not something of which I am aware right now. If he allows me, I will certainly look into it and write to him.

Pete Wishart: I thank the Leader of the House for announcing the business for next week. I also extend birthday wishes to the hon. Member for Gateshead (Ian Mearns). I always tell him that he is the finest Chair of the Backbench Business Committee that we have. I wish all London marathon participants from the House all the best on Sunday. A record 18 MPs will be running, including two Scottish National party Members of Parliament—Lightspeed Linden and Supermac Stuart McDonald—who will be running for charity.
Regardless of what the Leader of the House says, this has not been one of her finest weeks in the job. The structuring of parliamentary business at the beginning of this week was an utter shambles. I do not know what she was thinking in trying to discuss the Syrian air strikes in a debate under Standing Order No. 24; she is in charge of the business, for goodness’ sake. It is ridiculous that I am having to tell her that she could have tabled a motion on Syrian air strikes at any time. I ask her once again: will she now table a proper, amendable motion with a full day’s debate on the situation in Syria?
And what about the heroes in ermine, eh? The tribunes of the people and the red remoaners, who have somehow managed to thwart the Government’s chaotic and clueless Brexit? When I look around at my Conservative friends, I wonder whether some of them might now be a little more disposed to dealing with the House down the corridor, which is a national embarrassment, even though its Members are doing the right thing this time. I am saying to Conservative Members of this House, come on and join us! Let us get rid of the Lords from the face of our democracy, because it is an utter national embarrassment to this country and to what we call our democracy.
We need a full debate on what has happened regarding the Windrush generation; the cases and issues are getting more alarming and concerning. We have now heard that the policy described as creating a “hostile environment” passed in the Immigration Act 2014—supported by the Labour party, it has to be said—was opposed and objected to by Ministers and civil servants. But it certainly informed the whole approach to the Windrush victims.
Now, I am not against hostile environments. In fact, I would quite like a hostile environment for Faragist-informed Conservative Ministers, but this issue will not go away; it is going to get worse and worse for this Government. They should have learnt lessons from the Syrian air strikes, and come to the House with a proper motion and a full debate on what is happening on this appalling issue.

Andrea Leadsom: Perhaps if the hon. Gentleman were to participate in the London marathon himself, he might be a little distracted and less willing to let his blood pressure get as high as it obviously has today. I certainly congratulate his hon. Friends and all Members who are taking part in the London marathon; they are definitely braver than me.
The hon. Gentleman raises an important point about the order of business this week. Mr Speaker, I know that you shared the desire of all Members across the House to see urgent debates on the subject. The Prime Minister herself applied for such a debate, on the grounds that the only practical way to change the order of business on a given day is through an urgent debate request.
Mr Speaker was pleased to grant an urgent debate to the hon. Member for Wirral South (Alison McGovern). All hon. Members, including Conservatives, were pleased to stand in support of that. As the Prime Minister said, she was determined to be held accountable for her actions by the House. There was no question about it. At the same time, she also made it very clear that it was vital that she took action in such a way as would protect our armed forces, secrecy around the limited nature of the targets and secrecy around the extent of the operation, in order for that operation to be effective.
Following the Prime Minister’s action, which was entirely within the conventions of the House, she came to the House—facilitated in no small part by Mr Speaker himself—and made a three-and-a-quarter-hour statement, answering 140 individual questions. She then took part in a debate, answering 27 individual interventions from right hon. and hon. Members. She also took part in a further urgent debate the following day. It is simply unfair and ungenerous to suggest that anybody in this place was seeking to avoid accountability. The Prime Minister was absolutely clear about her intentions.

John Hayes: Coming into the House on Monday, I encountered, by chance, on the wireless an interview with the mother of a young boy murdered with a knife. In calling for tougher sentences and more stop-and-search, that mother chillingly declared that politicians did not care because their children were not at risk. I know, as you do, Mr Speaker, that people across this House do care. So, will the Leader of the House arrange for a debate on knife crime and the culture, which is gaining hold in our cities and elsewhere, that not only allows but celebrates the carrying and use of knives?

Andrea Leadsom: My right hon. Friend raises an incredibly important point that hon. Members across the House have previously raised. He is exactly right to point out that we have seen an increase in the appalling use of knives in fights, particularly among younger people, the causes of which are very complicated: the increased use of county lines, drug use and so on are partly responsible.
I assure hon. Members that my right hon. Friend the Home Secretary is determined to take early action. We have had a number of discussions about what more can be done. In March, she launched a national knife crime media campaign across all channels, including billboards, to try to take young people away from this awful scourge. We are doing a great deal more intervention work in hospital A&Es, trying to appeal to those who have already experienced some sort of knife attack. We are awarding significant sums to community funds and to community groups who are tackling gangs and knife crime. My right hon. Friend has also launched the serious violence strategy. We will be bringing forward an offensive weapons Bill to try to limit access to and use of knives.

Ian Mearns: I have to say to the Leader of the House that I followed Her Majesty by some 31 years, so I am not just behind her, but despite my tender age, Tyne and Wear fire service has advised no candles on the cake this year.
I am glad to see from today’s Order Paper that the Backbench Business Committee is to get reinforcements in the shape of the hon. Member for Gordon (Colin Clark). I am very glad that we have now got back our full complement. However, even with eight members and a quorum of four, it is sometimes difficult to get that quorum when members have been called away to Statutory Instrument Committees and so on. Could we please look at this again? It seems rather unfortunate to have a quorum of four for a Committee of eight.
I am afraid that it looks as though De La Rue has thrown in the towel on the production of UK passports in Britain. I would like a statement from the Home Secretary about exactly where and how our passports will be produced post-2020. De La Rue has done an awful lot of work in looking at the bids being put in by Gemalto in Paris. It seems to De La Rue—and to me, I think—that it is very likely, with the costs that have been provided, that post-2020 our passports will be produced, or mainly produced, in eastern Europe or in the far east. It is not a satisfactory situation, post-Brexit, for the UK—an independent nation, proud of itself—to have its passports produced far, far away.

Andrea Leadsom: I am grateful to the hon. Gentleman for clarifying the issue of age. He would admit to being a young whippersnapper by comparison, I am sure.
The hon. Gentleman raises a very important point about the quorum. I have taken soundings, as I said I would. The concerns are about whether a quorum below four is truly evidence of cross-party decision making. If he were to write to me, I could perhaps liaise with the Procedure Committee, which might be persuaded to look into this from a more formal point of view. I do understand the practical points he raises, but he will, I am sure, equally appreciate that, to be truly cross-party, four is a pretty small number of people to have in the decision-making process.
The hon. Gentleman will appreciate that De La Rue prints passports, security documents and money for countries right across the world. The UK, as we seek to leave the EU, will be a global champion for free trade, and so this cannot be one-sided. We need to accept that, just as our brilliant UK businesses generate income and profits from overseas, so other businesses must be able to compete in the UK market.

Bill Cash: In relation to the point of order I raised a short time ago, will the Leader of the House arrange for a debate—in consultation, of course, with the Privileges Committee—on the principles and practice by which the House deals with questions of molestation, abuse and intimidation of Members of Parliament, including on social media, and by reference not only to the hon. Members for Stoke-on-Trent North (Ruth Smeeth) and for Liverpool, Wavertree (Luciana Berger), but to all others?

Andrea Leadsom: I listened with great interest to my hon. Friend’s point of order and I am extremely sympathetic to it. As you will know, Mr Speaker, I have also raised  with you the issue of how social media can be used to intimidate Members and, potentially, to put out slanted versions of what takes place in the Chamber. I am sympathetic to my hon. Friend and will be happy to look into this if he wants to write to me. I know you have also asked him to raise it with you, Mr Speaker.
My hon. Friend will appreciate that the investigation by the Digital, Culture, Media and Sport Committee into fake news may look at these issues, and he will also be aware that the Department for Digital, Culture, Media and Sport is looking carefully at an internet safety strategy for keeping young people safe online, and at seeking further ways to stamp out the sort of horrific abuse that has been described in the Chamber this week.

Siobhain McDonagh: In January 2013, Kevin Doherty was found guilty of the manslaughter of his partner Jane Harrison. It had taken 18 years to bring him to justice, and he is still to disclose the location of Jane’s body to her family. In January this year he was granted a transfer to an open prison without reference to the Harrison family. How is that just or fair? I have written to the Ministry of Justice without success four times seeking a meeting with the appropriate Minister. Perhaps only a debate on the treatment of the families of victims will elicit any justice for the Harrison family.

Andrea Leadsom: The hon. Lady raises a truly harrowing case and I am sure that all Members send their deepest sympathy to the family of the victim. I am happy to take up the lack of response with the Ministry of Justice on her behalf if she would like to write to me.

Ian Liddell-Grainger: Following on from the point made by my hon. Friend the Member for Christchurch (Sir Christopher Chope), I have the same situation. May we have a debate in Government time on local democracy? My locals have been stamped on and ignored, and now they are being told by the Secretary of State that they will have what they get. I have total sympathy with the situation in Christchurch, so may we have a debate on local democracy before it is trodden on by this Government?

Andrea Leadsom: My hon. Friend raises an important constituency point. He may wish to seek an Adjournment debate. I also draw his attention to the fact that Ministers from the Department will answer oral questions on 30 April—he may wish to raise the issue directly with them.

Vernon Coaker: I join the right hon. Member for South Holland and The Deepings (Mr Hayes) in pressing the Leader of the House to have an urgent debate and a continuing report from the Home Secretary on the serious violence strategy she has announced. The young and the middle-aged in London and across the country are being stabbed and becoming the victims of violent crime. We are seeing huge increases in violent crime. This is an emergency for the Government and the House should discuss it regularly. Local communities, including Nottingham Forest Football Club and Notts County Football Club, are coming together to try to tackle and stand up against this increase in violent  crime, but we need the Government to report regularly to Parliament on what they are doing to tackle this scourge.

Andrea Leadsom: I completely agree with the hon. Gentleman. We must do everything we can. I have tried to set out how, through the serious violence strategy, the Government are seeking to provide funding for community efforts, and to use a national media campaign to take young people away from this seemingly attractive lifestyle of joining a gang and being involved in this appalling violence. We are working with young people who have already been stabbed and are in hospital, and trying to turn them away from that lifestyle before it is too late. The hon. Gentleman is right to say that more could be done, and I recommend that he seeks a Backbench Business Committee debate so that all Members can share their thoughts on the subject.

Kevin Hollinrake: Understandable changes to the parliamentary timetable this week precluded the opportunity to debate the hugely important banking scandals, and the effect that they had on thousands of business people around the country. Will my right hon. Friend find Government time to debate that important issue?

Andrea Leadsom: I agree that that is an important issue. The loss of livelihoods following the financial crisis was a devastating blow for many people. I will certainly take my hon. Friend’s request away and see whether it can be accommodated.

Tom Brake: Will the Leader of the House make available Government time for a debate to be led by the Prime Minister, in which she could explain that a logical consequence of her hostile immigration environment is the hurt caused to the Windrush citizens, and the creation of citizens of nowhere? She could also provide a guarantee that no Windrush citizens will be harassed by the Home Office, and that EU citizens in the UK who are applying for settled status will not be faced with threats of deportation if their indefinite leave to remain papers no longer exist.

Andrea Leadsom: The right hon. Gentleman will be aware that the Prime Minister and the Home Secretary have both apologised unreservedly and made clear their commitment to putting this right. There is no question but that the Windrush generation are British and deserve to have all the same rights as citizens. He raises an important point about EU citizens, and I regret anybody seeking to cause a lack of confidence and destabilise the feelings of EU citizens—[Interruption.] No, I am sorry. The Prime Minister, the Home Secretary, Ministers from the Dispatch Box and I have all been absolutely clear: EU citizens who have come to the UK, made their lives here and contributed to the United Kingdom, are welcome here, and their rights will be protected. It is not the same situation at all.

Maggie Throup: As the new chair of the all-party furniture industry group, may I make an early plea to my right hon. Friend for a debate in Government time to highlight the significant contribution  that the furniture industry makes to the UK economy? May I urge her to exploit the unique skills of our British furniture manufacturers when we commence work on the restoration of this place?

Andrea Leadsom: I congratulate my hon. Friend on her new position. I am a big fan of that industry—my mother and stepfather had a furniture shop when I was growing up. The furniture industry is dominated by small and medium-sized enterprises, and in 2017 alone it contributed nearly £3.9 billion to the UK economy, employing more than 90,000 workers. I assure my hon. Friend that the restoration and renewal programme will consider how the UK furniture sector can benefit from the restoration of our grade I listed palace.

Emma Hardy: I hope Members across the House share my anger with the multinational waste management company FCC Environment. It is refusing to grant all its workers the basic right of sick pay, despite one of those workers suffering from cancer, despite workers offering to give up their annual bonuses to help cover the cost, and despite the fact that all the management team receive sick pay. May we have a debate in Government time on whether any public contracts should be given to companies that do not offer something as basic as sick pay for all their workers?

Andrea Leadsom: The hon. Lady raises a worrying situation. She will be aware that the Government’s Taylor review has raised all issues of the rights of workers and the way they are treated, and the Government will bring forward measures to ensure that any public procurement takes into account the importance of the rights of workers. I encourage the hon. Lady to seek an Adjournment debate so that she can raise this specific case directly with Ministers.

Peter Bone: It has been a strange old week for Parliament: money resolutions not provided and blocking a private Member’s Bill; a Government motion signed by the Leader of the House and the shadow Leader not moved by the Government; and a Standing Order emergency application from the Government to destroy their own business. The real Whitehall farce of the week, however, was when the Leader of the Opposition had an emergency debate. Government Members were called back from everywhere to vote against the motion and the Leader of the Opposition got all his Members to vote against the motion. The Government voted for the Corbyn motion and Labour MPs voted against it. It was carried by a massive majority and not a single Labour MP supported it. Leader of the House, that is a nonsense! We have to change this and the simple way to do it is to have a business of the House committee. May we have a debate in Government time on this matter?

Andrea Leadsom: My hon. Friend raises a real mish-mash of issues. On private Members’ Bills, he will be aware that a money resolution is being brought forward in due course as soon as we can do so. On Select Committee term limits, he, and I am sure you, Mr Speaker, would agree it is perfectly orderly for a Member whose name is on a motion to bring it forward. As another person whose name was on that motion, I am pleased that it  has now been passed, giving Select Committee term limits of 10 years rather than eight years during this Parliament.
My hon. Friend also raises urgent debates. I have gone into some detail on the importance of the Government being held to account as early as possible on Monday. The practical way to do that is through an urgent debate, which you, Mr Speaker, were pleased to give. I do not think my hon. Friend has raised a succession of arguments for reform. To be very clear, a Committee of the whole House would not be able to deal with some of the many necessary changes to business.

Peter Bone: Yes it would.

Andrea Leadsom: The reality of trying to call a committee in short order to deal with very fast moving situations makes it entirely impractical. Having looked carefully at this issue, the Government have decided that it would not be a workable solution.

John Bercow: I should just say to the hon. Member for Wellingborough (Mr Bone), and for the benefit of other Members, without in any way dissenting from anything that the Leader has just said, that it is perfectly open to the House to amend Standing Order No. 24, of which there is some uncertainty and often incomprehension. It could be amended to allow for the tabling of substantive motions in circumstances of emergency, which could also be amendable and on which the House could vote. If there are Members who are interested in that line of inquiry, they could usefully raise it with the Chair of the Procedure Committee, the hon. Member for Broxbourne (Mr Walker), but it is a matter for Members.

Barry Sheerman: On a lighter note, the sun is shining and it is obvious it is now spring. I always feel it is spring when the London marathon takes place. So many people run the marathon—not me, thank goodness—to raise money for charities, particularly heart and cancer charities. May we, from across the House, congratulate them all?
Many hon. Members, including the hon. Member for Bridgwater and West Somerset (Mr Liddell-Grainger), are calling for a debate on local democracy. Local democracy is fundamental to this country. We are all part of local democracy and products of it. May we have an urgent debate on local democracy? There is a big decline in social and community networks in our towns and cities, because, due to cuts to their budgets, local authorities are no longer able to support them.

Andrea Leadsom: First of all, I join the hon. Gentleman in congratulating the 18 Members of Parliament and the thousands of others taking part in the London marathon, in particular Mo Farah, whom a number of us will be cheering on.
The hon. Gentleman asks for a debate on local democracy. A Westminster Hall debate or a Backbench Business debate can always be sought to share issues and ideas on local democracy. I draw his attention to departmental questions on 30 April, when he can raise it directly with Ministers.

Andrew Jones: I recently visited ILKE Homes, which is developing a factory near Knaresborough for the off-site pre-manufacture of homes. Other comparable initiatives are taking place  across the country. This is an exciting development for the housing sector, as it will deliver houses quicker, with improved environmental benefits and at a cheaper cost. I was certainly impressed by what I saw at ILKE, so please could we have a debate about new methods of construction in the infrastructure and housing sectors, so that we can highlight the emerging benefits?

Andrea Leadsom: My hon. Friend raises a really good point. The idea of manufactured housing can certainly contribute to the Government’s principal domestic priority, which is to ensure that everybody has the chance to have their own home. It is encouraging to see companies such as ILKE Homes using modern methods of construction. Throughout 2017, we saw continued growth in modern methods of construction across all sectors, and the Government’s home building fund is providing support for those methods. We should encourage all businesses looking at this to continue to do so.

Nick Smith: Nearly 7,000 jobs and our steel industry rely on the contract for three new ships to support our aircraft carriers. The Government must get behind our shipbuilding and steel industry, so can we have a statement on defence procurement?

Andrea Leadsom: We are all very proud of our shipbuilding sector, which is in a good position and has had some huge successes with our new shipbuilding programme. I am sure that the hon. Gentleman will welcome the Government’s commitment to provide not just a decent, home-grown future plan for new ships, but to seek to win orders from overseas as well. If he wants to seek a specific debate on shipbuilding, I recommend that he asks for an Adjournment debate so that he can raise the issue directly with Ministers.

John Howell: Can we have a debate on the work of the Council of Europe, hopefully on an annual basis? As we leave the EU, it becomes the most important organisation in Europe of which we are still a member, and yesterday there was cross-party agreement to such a debate.

Andrea Leadsom: My hon. Friend makes a really interesting suggestion, and I am certainly happy to take it away and look at it.

Vicky Foxcroft: I echo the calls from the right hon. Member for South Holland and The Deepings (Mr Hayes) and my hon. Friend the Member for Gedling (Vernon Coaker) for us to have a debate on youth violence and the Government’s serious violence strategy. It might be helpful if I remind the Leader of the House of her comments on 29 March. On the strategy being published, she said:
“It will be very important, when the strategy comes forward, for the House to have a chance to debate it”.—[Official Report, 29 March 2018; Vol. 638, c. 957.]
If she is worried about what the Home Secretary might think about this, when she was asked about this on 16 April, she said:
“I will take that very good question to the Leader of the House. I would relish such a debate.”—[Official Report, 16 April 2018; Vol. 639, c. 24.]
When are we going to have that debate on the serious violence strategy?

Andrea Leadsom: I pay tribute to the hon. Lady, because she raises this issue frequently in the Chamber and I know that she is absolutely committed to doing everything that she can to eradicate this appalling increase in knife crime. I have already mentioned the steps that the Government are taking. I hear what she says about having a debate, and I will certainly take that away and see what can be done.

Andrew Bowie: Agricultural machinery rings, such as Ringlink in my constituency—I have visited Ringlink, which has in excess of 2,700 members—play a vital and yet undervalued part in running a modern agricultural business by matching a shortage of machinery and labour on some farms with a surplus on other farms. Will my right hon. Friend consider a debate in Government time on the vital part played in rural economies by businesses such as Ringlink and other machinery rings across the country?

Andrea Leadsom: My hon. Friend asks a very good question. Collaboration between farmers can bring real economic benefits and help them to benefit from economies of scale, to share knowledge and share machinery, and of course, to jointly market their produce. Ringlink is a great example of a collaborative organisation that has managed to evolve in response to changing industry needs. The Government are keen to support that type of work in the agriculture sector, so in February this year we announced a £10 million collaboration fund to bring together those who are interested in greater co-operation.

John Cryer: Let me first associate myself with the comments made by the Leader of the House about the anniversary of the foundation of Israel. That was a great achievement by a great Labour Government and a great Labour Foreign Secretary.
Three Members have asked questions about the wave of violent crime that is sweeping the whole of Britain to some extent, but especially London, and east London in particular. Given that it cannot be dissociated from the loss of police officers and police stations, we urgently need a debate about crime, policing levels and police station closures.

Andrea Leadsom: I entirely share the hon. Gentleman’s concern about the increase in crime levels, particularly in London. As I said earlier, on 8 April the Government announced plans for an offensive weapons Bill, which will make it illegal to carry corrosive substances in a public place. We will consult publicly on extending stop-and-search powers to enable the police to seize acids from people who are carrying them without good reason. The Bill will also make it illegal to possess certain offensive weapons, and we are taking a raft of other actions in the serious violence strategy. However, I hear from all Members that there is a strong desire for a debate on this subject, and I will certainly look into what can be done.

Philip Davies: The disappointing profits results issued by Debenhams today follow hot on the heels of the difficulties that high street names such as Maplin, New Look and Toys R Us are experiencing. May we have a debate on what the Government can do  to help high street retailers, especially those in small towns such as Shipley, Bingley and Baildon, which are having a very difficult time? Could we discuss in particular how we can help them to compete against online retailers by, for instance, doing something about business rates, so that the bricks-and-mortar retailers that are so needed and so welcome on our high streets can continue to thrive rather than struggling, as I am afraid they are at the moment?

Andrea Leadsom: l think we are all concerned about the health of the high street shopping centres in our constituencies, and my hon. Friend is also right to refer to online competition. Business rates may indeed be making the difference between bricks-and-mortar retailers and those that are doing better online. My hon. Friend will be aware of our measures to reform business rates and try to create a more level playing field. Measures such as Small Business Saturday and the work that we all do as Members to promote our own small shopping areas are obviously important, but he may wish to seek an Adjournment debate so that he can talk directly to Ministers from the Department for Business, Energy and Industrial Strategy about what more we can do.

Jonathan Edwards: The day before a recess, I am reliably informed, is known as “take the trash out day” in Government circles. Before this year’s Easter recess, the Department for Culture, Media and Sport published its long-awaited review of the future of S4C. I am sure that the British Government would want to avoid the impression that they would refer to my country’s primary asset in such derogatory terms. May we have a debate in Government time, or at least an oral statement, on this important issue?

Andrea Leadsom: Let me first reassure the hon. Gentleman that the reason there is often a flurry of activity on the day before recesses is that, far from  its being “take the trash out day”, the purpose is to ensure that the House is still sitting when important announcements are made so that they are not left until the House is in recess, which is precisely the opposite of what he has said. Let me also reassure him about the Welsh broadcasting channel: it is absolutely vital, and he may well want to seek an Adjournment debate so that he can raise the issue directly with Ministers.

Bob Blackman: Yesterday morning the Prime Minister welcomed Narendra Modi to No. 10 Downing Street, and yesterday evening I joined right hon. and hon. Members to attend events in Central Hall, where Modiji subjected himself to two and a half hours of detailed questioning.
At the same time, a quite disgraceful event was taking place in Parliament Square, where the Indian national flag, which had been raised to celebrate the Commonwealth Heads of Government meeting, was burned. Meanwhile, some disgraceful billboards were going around London comparing our good friend Narendra Modi to Hitler. I am all for free speech, but that seems to transcend free speech. May we have a statement from the Home Secretary about what will be done to prevent such actions from taking place in the future?

Andrea Leadsom: My hon. Friend has made a shocking announcement, and if he wants to write to me giving details of what he saw or heard, I shall be happy to take it up with the Home Secretary on his behalf.

Ian Murray: The data protection legislation currently going through the House is a welcome update to our legislative framework, but may we have an urgent statement from the relevant Minister on the unintended consequences that this legislation might have for MPs being able to communicate with their constituents?

Andrea Leadsom: The hon. Gentleman might be aware that a number of Members have raised this issue with me in recent days. Both the Department for Digital, Culture, Media and Sport and the Information Commissioner’s Office are putting out further advice for MPs. My own parliamentary staff undertook the first round of training, and found it much too generic: there was not enough detail about the consequences for pre-existing data we hold on constituents who have contacted us before, and so on. So there is now a huge effort under way to ensure that MPs get the advice they need so that they can be absolutely clear about the impact this has on their relationship with their constituents. To be clear, it is vital that our relationship with—our ability to communicate with, about and on behalf of—our constituents is not impaired in any way.

Bob Neill: In the first two months of this year, there were 413 domestic burglaries in the London borough of Bromley, some 32% up, and 38 of them were in the Chislehurst ward alone. They are largely carried out by organised gangs of criminals, almost invariably armed and willing to threaten, and sometimes use, violence. It is not unique to Bromley, either, or to other parts of London. Many of my constituents regard this as a crime of violence and think that, frankly, all domestic burglaries should be treated as crimes of violence because of the invasion of someone’s home, family and privacy. May we have a debate in Government time on having a joined-up strategy for tackling this through both police priorities and the sentencing framework?

Andrea Leadsom: I am sorry to hear about my hon. Friend’s experiences in his constituency, and of course any form of burglary, particularly when violence is threatened, is very frightening and harrowing for the victims. I encourage him to seek either a Backbench Business Committee debate or an Adjournment debate so that he can raise his particular concerns directly with Ministers.

Diana R. Johnson: In light of the decision of the Scottish Government, followed by the Welsh Government, to put the healthcare and dignity of women first by allowing abortion tablets to be taken at home, may we have a statement from the Secretary of State for England Health explaining why English women still have to attend an abortion clinic to get those medically prescribed tablets, and why we are still making the harrowing stories we hear of women who have miscarried on the way home from those clinics in public toilets or on public transport happen  in England?

Andrea Leadsom: The hon. Lady is right to raise this issue, and I encourage her to raise it at Health questions, but if she would prefer to write to me, I can take it up with the Department on her behalf.

Tom Pursglove: The issue of potholes is understandably troubling my constituents in Corby and east Northamptonshire, and I am delighted that Northamptonshire is to get an extra £1.6 million of Government funding to help with repairs, but Ministers must keep the resources under constant review, so may we have a statement on that next week?

Andrea Leadsom: I confess to having a great interest in my hon. Friend’s pothole problem since his constituency is just up the road from mine, and very often the journey there goes through both of our constituencies. Potholes are a disastrous problem, and it is at this time of year, after the long winter and when the roads are in a particularly bad state, that the potholes start getting repaired. Certainly in my area I am seeing some improvements, and I hope all hon. Members are in theirs, too. My hon. Friend raises an important point that affects all of us, and it is a perfect example of something the Backbench Business Committee might look at.

Kerry McCarthy: I recently had lunch at the Old Bailey with judges, and they told me that virtually every other trial they are handling at present involves knife crime, gang crime and teenagers. I then sat in and witnessed the trial of four teenagers who were convicted of murdering another teenager. That is such a tragic waste of life, so I just want to add my voice to those of the other MPs who have spoken about this matter. The House really does need to debate it, and I hope the Leader of the House will give it parliamentary time.

Andrea Leadsom: I thank the hon. Lady for her question. I think she is about the sixth hon. Member to raise this issue, and I will certainly go away and look at it carefully.

Martin Vickers: There is traffic chaos in north-east Lincolnshire due to the number of temporary traffic lights. Some have been installed for essential roadworks, but the council is failing to co-ordinate these operations. May we have a debate on how local authorities deal with these situations? Motorists are frustrated, traders are becoming increasingly angry and we need action.

Andrea Leadsom: My hon. Friend is a great spokesman for his constituency, and I can well imagine the frustration caused by poorly co-ordinated roadworks and permanently “temporary” traffic lights, which are very frustrating for motorists. I encourage him to seek an Adjournment debate or to write to Ministers on the specifics in his constituency.

Clive Efford: May we have a debate to mark the 25th anniversary of the murder of Stephen Lawrence in Eltham? It was a seminal moment for race relations in our country, and it should be recognised in some way by the House. Such a debate would give us an opportunity to distance ourselves from the remarks  made by Mr Mellish, the former detective, on last night’s documentary, in which he accused Stephen Lawrence’s mother of having a gimmick in not smiling. She was a bereaved mother who had lost her son in the most tragic circumstances, and she was let down by the Metropolitan police, which was found to be institutionally racist. Mr Mellish was a fine example of that last night, and we should be given the opportunity to distance ourselves from individuals such as him.

Andrea Leadsom: I am very sympathetic to what the hon. Gentleman says. We all have our own recollection of the appalling night on which Stephen Lawrence was murdered, of the bravery of both his parents in their own ways in the subsequent years, and of the lessons learned by the police forces. Our current Metropolitan Police Commissioner, Cressida Dick, has shown her commitment to stamping out any form of racism, which is vital for all of us, but the hon. Gentleman is right to say that Stephen Lawrence’s appalling death must never be forgotten.

John Bercow: Pursuant to the hon. Gentleman’s inquiry and to what the Leader of the House has said, I believe I am right in saying that there is to be a commemorative service at St Martin-in-the-Fields next Monday to mark the 25th anniversary of that appalling murder. I think I am also right in saying that our admirable Chaplain, Rev. Rose Hudson-Wilkin, will be preaching at the service. I hope colleagues will agree that that is singularly appropriate.

Wayne David: Mr Speaker, at the last business questions, you stated that you expected the Government to make an announcement in the House of Commons about the awarding of the mechanised infantry vehicle contract. In fact, that announcement was made during the recess, on Easter Saturday—a time, I would suggest, deliberately designed to minimise publicity and avoid scrutiny. May we have a debate in Government time in this House as soon as possible on that important £2 billion contract?

Andrea Leadsom: First, I reiterate my commitment to ensuring that Parliament is the place where as many announcements as possible are made. I also draw the hon. Gentleman’s attention to the fact that we will have Defence questions on Monday, so he will have an opportunity to raise his concern directly at that point.

Kelvin Hopkins: The Leader of the House will recall that I recently raised in business questions the problem of addiction, including compulsive gambling. One of the most dangerously addictive forms of gambling is online gambling, and she might have seen that one of the German Länder has recently legislated to prevent online gambling in that area. Will she urge her Government colleagues to look at that German initiative in addressing the scourge of gambling addiction?

Andrea Leadsom: The hon. Gentleman is right to raise this point. Addictive online gambling is absolutely destroying lives, and the loss of income and vital family money is appalling. If he would like to write to me separately, I can take the matter up with Ministers on his behalf.

Patrick Grady: May we have a debate on community sport and active lifestyles, such as those promoted by local bowling clubs? I had the pleasure of attending Kelvindale bowling club in my constituency for the opening of the season, and I am proudly wearing its tie today. Will the Leader of the House join me in wishing all the best to that club, to clubs across the country, and indeed to the Scotland team, all of whom came home from the Commonwealth games with one kind of medal or another?

Andrea Leadsom: I am always delighted to congratulate those involved in all sporting efforts, including the bowling team that the hon. Gentleman mentions, and, of course, I congratulate Scotland and all parts of the United Kingdom on an excellent Commonwealth games.

Alex Norris: Every weekend, hundreds of thousands of men, women and children make their weekly pilgrimage to watch their football team. In the top two tiers of English football, they can only do so sitting down. This is unsafe, as it is not universally observed, and it is bad for the atmosphere. It is time to permit safe standing, as they do in Scotland and other parts of Europe. May we have a debate on this matter in Government time?

Andrea Leadsom: The hon. Gentleman will be aware that there are arguments for and against standing and sitting in football stadiums and we have our own horrendous examples of unfortunate and appalling circumstances involving standing. I am sure that he will appreciate that it is not an easy issue to decide one way or the other. I encourage him to take the matter up directly with the Department for Digital, Culture, Media and Sport and see what progress it is making.

Kevin Brennan: On the subject of the London marathon, not only is my hon. Friend the Member for Blaenau Gwent (Nick Smith) running but so is my hon. Friend the Member for Darlington (Jenny Chapman). This will make them the first husband and wife team from the House of Commons to run the London marathon—

Valerie Vaz: She’ll win.

Kevin Brennan: She may indeed.
I confess that I do not read the impact assessment for every Bill placed before the House, and the Leader of the House has mentioned a large number of Bills, but I was surprised to read in the Daily Mail this morning a quote from the Home Office on the Bill that became the Immigration Act 2014 that said that Ministers would not have been required to sign off the impact assessment. Is it the case that under this Government Ministers will introduce Bills into the business of the House of Commons without knowing what their impact is?

Andrea Leadsom: I did not read the article in the Daily Mail that the hon. Gentleman mentions. My understanding, having been a Minister for some four years, is that Ministers sign off on impact assessments, but whether there are some that they do not sign off I am genuinely not aware, so I will write to him.

David Linden: May we have an urgent statement from the Government urging people to get behind London marathon runners this weekend, of which I am one? Will the Leader of the House join me in praising the work of Glasgow EastEnd Community Carers and encourage generous Glaswegians to get right behind me and donate—and will she possibly donate herself?

Andrea Leadsom: I believe that the hon. Gentleman is now known as Legs Linden—is that it? I encourage him to go for it; we are proud of him and all colleagues taking part in the London marathon, particularly for such a great cause. I encourage the hon. Gentleman’s charity in all it does to try to help people.

Paul Sweeney: On Monday, I had great pleasure in attending Channel 4’s announcement of the biggest restructuring of the channel in its 35-year history, with the “4 all the UK” programme to disperse its headquarters out of London to different cities around the UK. I have every confidence that my city of Glasgow, with its excellent strengths in broadcast media, production and education in media, will have a good strong chance of securing one of those headquarter facilities. Will the Leader of the House consider calling a debate so that MPs from across the UK can advocate for their constituencies to be the home of the Channel 4 headquarters?

Andrea Leadsom: I am certainly glad that the hon. Gentleman has made that early pitch for Glasgow. I am sure that plenty of people will have heard it and I am sure that all hon. Members will find their own way of putting their pitch forward so that their cities can take part in Channel 4’s dispersion arrangements.

Martin Whitfield: I associate myself with the question asked by the hon. Member for Thirsk and Malton (Kevin Hollinrake) about the loss of the Backbench Business Committee-sponsored debate on the banks on Tuesday, for very important reasons. Many thousands of our constituents are waiting for the debate. They are waiting to hear answers to questions that they have raised over many years. I would be grateful if the Leader of the House indicated if the Government might be able to facilitate three hours, ideally on a Tuesday, for the debate to take place.

Andrea Leadsom: As I said to my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), I apologise for the circumstances that led to the Backbench Business Committee deciding not to hold that debate and further apologise for the fact that that was the second time it happened. I absolutely recognise the importance of the debate. We need to have it and, as I said to my hon. Friend, I will take it away and see whether we can offer Government time while appreciating, as I know hon. Members do, that there is a premium on legislative priorities.

Stewart McDonald: Following a freedom of information request from the GMB union, shipbuilders in Scotland have learned that the Government are putting out the Royal Fleet Auxiliary ships to international tender. That is despite the fact that the Government do not have to do so, despite the  fact that they could secure almost 7,000 jobs here and despite the fact they could generate millions of pounds for the Exchequer. May we have an urgent statement, not leaving it to Defence questions on Monday, so that the Defence Secretary can give a proper explanation of himself?

Andrea Leadsom: I am not aware of that freedom of information request, but I encourage the hon. Gentleman to raise it at Defence questions—it is only on Monday, so it is not too long to wait—so he can raise it directly with the Secretary of State.

Andrew Slaughter: May we have a debate on the “really hostile environment” the Prime Minister has created for migrants to the UK? Almost half of my constituents were born outside the UK. Many face harassment by the Home Office, and 40% of my EU citizens report negative experiences following the Brexit vote. It is not only the Windrush generation but more recent migrants who are suffering victimisation and discrimination by this Government.

Andrea Leadsom: This country is incredibly welcoming to immigrants. We have one of the broadest ranges of people coming to this country from across the world to make their life here. This country is, in fact, very welcoming to immigrants. The Prime Minister herself has carried out the first ever race disparity audit to look at the areas where integration has been more difficult and to take action in those areas. I simply do not recognise what the hon. Gentleman is saying about the Government’s policy.

Alan Brown: Claims helplines are supposed to be free phone numbers. In answer to a written parliamentary question, the Department for Work and Pensions confirmed that the employment and support allowance helpline became a free phone number on 7 December, but the most prominent number available online is an 0843 number, which is chargeable. Last month one of my constituents was charged £72 over the month for phone calls made to that number. Will the Leader of the House make a statement outlining what the Government will do to make sure that only free phone numbers are used and that information on those numbers is widely available online? Does she agree that my constituent should get a refund from the DWP?

Andrea Leadsom: The hon. Gentleman raises a very important point. If he writes to the Secretary of State for Work and Pensions, I am sure she will respond. If he wants to do that through me, I am happy to take it up with my right hon. Friend on his behalf.

Justin Madders: My constituents, Mr and Mrs Dodd, face losing their home next month as a result of a personal guarantee they signed with Goldcrest Distribution Ltd. The case highlights the lack of safeguards for individuals who sign such agreements and the unreasonable way that finance companies pursue such debts. An offer to repay nearly double the loan amount was rejected, and the debt continues to increase at a rate of over £300 a day, thanks to interest rates at which even Wonga would blush. Please can we have a debate on more protection for individuals in these circumstances?

Andrea Leadsom: That is a particularly awful story. Having been City Minister some time ago, I have heard similar stories of the appalling way that some individuals are treated by finance companies. The hon. Gentleman is right to raise the issue, and I encourage him to write to the Financial Conduct Authority to see whether it can take action on behalf of his constituents.

Stuart McDonald: Despite this horrendous heatwave, I am still looking forward to joining 17 colleagues on both sides of the House in trying to complete the marathon on Sunday. I will be raising money for Spina Bifida Hydrocephalus Scotland. On that note, may we have a debate in Government time on why they continue to resist calls from the Food Standards Agency, the Scottish Government, the Welsh Government and others for the mandatory fortification of flour with folic acid? It has been shown in other countries that fortification can significantly reduce the number of pregnancies affected by neural tube defects, including spina bifida.

Andrea Leadsom: I also congratulate the hon. Gentleman. An impressive set of colleagues are taking part in the marathon. Let us hope it is just cool enough for them all to finish.
I also pay tribute to the hon. Gentleman for raising money for Spina Bifida Hydrocephalus Scotland, which is a vital charity. He has campaigned on this subject for some time, and I encourage him to continue raising this issue with Ministers.

PRIVATE RENTED SECTOR

HOUSING, COMMUNITIES AND LOCAL GOVERNMENT COMMITTEE

Select Committee statement

Clive Betts: I am grateful to you, Mr Speaker, and to the Backbench Business Committee for allowing me time, on behalf of the Housing, Communities and Local Government Committee, to speak to the House today about our fourth report of this Session, which is on the private rented sector. The report concentrated on: the quality of accommodation; the balance of power between tenants and landlords; the legislative framework; and enforcement
This Committee last considered the private rented sector in a report in 2013, following which the Government carried forward many of our suggestions, including a reformed approach to selective licensing, the mandatory licensing of houses in multiple occupation and a new regulatory model for letting agents. We hope the Government will take forward many of our recommendations this time, too.
The private rented sector has doubled in size in the past 15 years. There are now 4.7 million households in the sector, including 1.8 million families with children, which represents 20% of all households. Statistics show that most housing in the sector is adequate, although Shelter told us that 53% of tenants had experienced at least one problem with conditions or repair in the past year. Although the overall proportion of inadequate properties in the sector has fallen, the absolute number has increased, and a significant minority of private rented accommodation continues to be shockingly inadequate. The English housing survey shows that approximately 800,000 private rented homes in England have at least one category 1 hazard, such as excess cold, mould or exposed wiring. In our online forum, we heard directly from tenants about the poor conditions they had suffered. One submission said:
“We live in a house full of mould and damp with four young children…We have …faulty electrics and water comes through the living room window when it rains…the whole family keeps getting ill from it.”
We wanted to know about the power relationship between landlords and tenants: are tenants, especially those at the lower end of the market, able to complain and get their problems attended to? Unfortunately, the answer is no. Citizens Advice told us that 44% of tenants said that a fear of eviction would stop them from negotiating with their landlord over disrepair. Shelter and Citizens Advice told us that they often reminded tenants about the risks of making complaints. We heard that 14% of tenants felt that they had been penalised for complaining, and more than 200,000 reported having been abused, threatened or harassed by a landlord. We found that there is a clear power imbalance, and we called on the Government to consider extending protections which they rightly introduced in the Deregulation Act 2015. We also agree with the Government that a specialist housing court would provide a more accessible route to redress for tenants and urge them to issue more detailed proposals as soon as possible.
We looked at the overall legislative framework. The Residential Landlords Association told us there were 140 Acts of Parliament and more than 400 regulations affecting landlords in the sector. Our 2013 report called for that to be consolidated and made simpler. Since then, we have had the Housing and Planning Act 2016, the Consumer Rights Act 2015, the Deregulation Act 2015 and many others, so the situation is even more complicated. Therefore, we recommend again that the Law Commission undertakes a review of the legislation and provides guidance as to whether a new approach would bring more clarity for tenants, landlords and local authorities.
We focused on the housing health and safety rating system, and heard that there is a lack of understanding about how it works among landlords and tenants, and inconsistent application by local authorities. We called on the Government to immediately update the guidance on the rating system and eventually to introduce a more straightforward set of quality standards that everyone can understand.
We heard near unanimous support for the Homes (Fitness for Human Habitation and Liability for Housing Standards) Bill introduced by my hon. Friend the Member for Westminster North (Ms Buck). We, too, offer our support for the Bill, but we want to make sure vulnerable tenants at the lower end of the market are able to make use of these powers. We have therefore called for free and easily accessible technical and legal advice to support tenants. As it is likely tenants will seek this advice from local authorities, it is vital that they are suitably resourced to provide this additional service.
Most local authorities told us they were satisfied generally with the powers they have. However, powers can be meaningless if they are not actually used, and a freedom of information request showed that six out of 10 councils had not prosecuted a single landlord in 2016. One council, Newham, was responsible for 50% of all prosecutions across the country—why is that? Clearly, the level of protection being offered to vulnerable tenants in many councils is not adequate. The reasons we heard were: the legislation is over-complicated, as I have mentioned; local authorities have insufficient resources; and some local authorities simply lack the political will.
On resources, the Local Government Association has identified a funding gap of £5.8 billion by 2019-20. The Chartered Institute of Housing showed that local authority spending on enforcement has reduced by a fifth over a six-year period. The Government have rightly introduced civil penalties of up to £30,000 and allowed local authorities to keep that money, and they brought in rent repayment orders—both were recommendations in the Committee’s previous report. Local authorities need further funding, though, and we hope the Government will work with them to try to achieve that.
Concerns were expressed that local authorities could not always cover the full cost of prosecutions, which might deter them from prosecuting some cases. The Minister said that local authorities’ duty was to prosecute regardless, but, being cash-strapped, they will often take the cost into account when they make decisions. We believe that courts should require offenders to pay costs that reflect the actual costs to local authorities of enforcement actions.
As part of our inquiry, we went to Newham to look at the enforcement activity there. I saw a garden shed configured to accommodate not one, but two households. We heard of about 25 people being accommodated in a  small three-bedroom house. People were living in a walk-in freezer. A family was living in a chipboard construction in a garden, with a fridge and a washing machine powered by a wire from the kitchen. These are shocking conditions, and the fines and civil penalties should be increased.
However, the very worst landlords, whose business model relies on the exploitation of vulnerable tenants, can make hundreds of thousands of pounds a year. To them, a civil penalty of £30,000, however large an amount that is, is merely a business expense. To deal with the worst of the criminal landlords, we call for local authorities to have the power to take action to secure the confiscation of properties from landlords who commit the very worst offences, and to break their business model, which relies on the exploitation of vulnerable tenants.
Aside from the adequacy of resources or the severity of penalties, variations in enforcement between councils indicate that some local authorities have placed a higher priority on standards than others. We have called for authorities to publish their enforcement strategies and for a national benchmarking scheme, so that residents can compare enforcement between authorities. Ultimately, we believe that the disparity can be addressed only through political leadership.
In recognition of the particular interests of some Members, we supported the findings of the all-party group on carbon monoxide, which has called for landlords to install carbon monoxide alarms in the rooms of private rented properties that contain any fuel-burning appliance. We also supported the call for the Government to implement mandatory five-yearly checks on electrical installations in private rented property—an issue on which the Government have been consulting.
Finally, we looked into selective landlord licensing schemes. Since April 2015, local authorities have had to seek approval from the Government for selective schemes that would cover more than 20% of their area or more than 20% of privately rented homes in it. We heard that decision making was too slow, lacked transparency and was over-bureaucratic. Even local authorities that had decided against implementing a scheme felt that the decision should rest at local level.
In our view, decisions to implement such schemes should be made locally, where there is greater understanding of local needs and politicians are directly accountable to their electorates. We recommend that the Government remove the 20% cap; however, the Secretary of State should retain a power to require local authorities to reconsider a decision to implement a scheme that does not meet the strict criteria already set out by the Government.
As the private rented sector continues to expand and people remain in the sector for far longer, the Government need to address the clear power imbalance between tenants and landlords, and to ensure that local authorities have the resources they need to enforce the even stronger laws that we are recommending, to protect the most vulnerable tenants living in the worst conditions.

Bob Blackman: It is good to see my friend the Chair of the Select Committee back in his place after his medical treatment. [Hon. Members: “Hear, hear!”] I agree absolutely with every point made in the  report. In respect of retaliatory evictions, does he agree that one issue that must be resolved is assured shorthold tenancies of six months, which are the norm for the private sector? If we extended those to three-year tenancies, that would strike a better balance between tenants and landlords.

Clive Betts: I absolutely agree. In our previous report—my friend, the hon. Member for Harrow East (Bob Blackman), was also a member of the Committee at the time—we called for longer-term tenancies and greater certainty and security. We recognise what the Government have done under the Deregulation Act 2015 in terms of protection against retaliatory evictions, but the problem in the current market is that if a tenant does not formally complain in writing to the local authority, and the local authority then does not get enforcement action, there is actually no protection. We also recognise that the new legislation coming in, such as the private Member’s Bill of my hon. Friend the Member for Westminster North (Ms Buck), could leave the tenant open to retaliatory eviction, and in that legislation there is no protection from it. That is why we say that we should look again at that particular issue.

Helen Hayes: It is very good to see my hon. Friend, the Chair of the Select Committee, back in his place. I am a member of the Committee and it was a pleasure to work with other members of the Committee on this report, with which I agree wholeheartedly.
A family with very small children living in poor-quality rented accommodation in my constituency were recently evicted after they complained that the ceiling in the bathroom had collapsed over the bath shortly after they had finished bathing their children. I have no doubt that the next tenant is now living in that property, and that it is the taxpayer who is lining that landlord’s pockets by paying the rent. Does my hon. Friend agree that it is entirely appropriate for this report to make the recommendation that, in such despicable circumstances, the state should have the power to remove such properties from those landlords so that they can be returned  to good use for families who need high-quality accommodation? Will he join me in calling on the Minister to progress that recommendation?

Clive Betts: I thank my hon. Friend for her best wishes. May I also thank her and the hon. Member for Harrow East for the work that they did on the Select Committee while I was off in March?
Absolutely. We heard that many landlords do an excellent job. There are some who do not do it quite as well as others, and there are some who are basically criminals—the word “rogue” is used, but they are basically criminals. They are exploiting both the tenant and the taxpayer. In those extreme circumstances, the ultimate power of not merely banning them from operating as a landlord, but taking that property off them, is something we hope the Government will seriously consider.

Kevin Hollinrake: I welcome the Chair of the Select Committee back to his place.
I recused myself from the Select Committee inquiry because of my own Member’s interests, to which, of course, the House can refer. My hon. Friend the Member for Harrow East (Bob Blackman) references longer tenancies, but does the Chair of the Select Committee accept that those should be introduced on a voluntary basis for fear otherwise of driving landlords out of the sector, thereby potentially reducing supply to this very, very important sector?

Clive Betts: We did not particularly consider that in this report. In our previous report, we said that Shelter had produced a good model, and that we encouraged the sector to look at it. We must make landlords more aware of what is on offer. Sometimes, there is a feeling that some letting agents encourage the delivery of shorter-term tenancies because—guess what?—they make money every time the tenancy is renewed. The Government are dealing with that element in terms of tenants paying those fees, but landlords should get a bit wise to this, because I think many would actually favour longer tenancies. Let us get the information out there and encourage it.

Rupa Huq: Last night, I attended a housing assembly at a West London Citizens meeting. Some 300 people from churches, schools and community organisations were present. One of the demands on our council candidates was for there to be greater landlord licensing and a charter of tenants’ rights. What did the Committee’s report say on that? From my recollection, when these subjects came up in the Homes (Fitness for Human Habitation and Liability for Housing Standards) Bill, some Government Members said that they would lead to too much red tape; I think many of them derive income from that source. What does my hon. Friend have to say on that?

Clive Betts: There are two issues there. We have talked about the power imbalance, and action can be taken particularly on retaliatory eviction and retaliatory rent increases to try to rebalance the power. We have also asked the Government to use social media to make more information available to tenants, rather than just using the written form. On licensing, what we are saying is that, essentially, this should be a local decision within the current criteria. I hear landlords say, “It costs us,” but what I say is that the landlords’ concern over selective licensing is not because of the fee that they pay, but because Her Majesty’s Revenue and Customs might suddenly realise that they are raking in an income and they might suddenly have to start paying tax on it. That is something we should welcome in terms of public resources—getting in more tax as a result of these schemes.

Andrew Slaughter: It is good to see my hon. Friend back in his place. He rightly highlighted the contribution that the Homes (Fitness for Human Habitation and Liability for Housing Standards) Bill, promoted by my hon. Friend the Member for Westminster North (Ms Buck), can make to tackling the really appalling conditions in the private sector. The Government are supporting the Bill—at the third time of asking—but it is still not being allowed into Committee. Will he use  his and his Committee’s considerable weight to ensure that the Bill does indeed pass, because we absolutely need its powers?

Clive Betts: I will certainly do everything I can. That was the view of the Committee, and of the House on the Bill’s Second Reading, which I was here for. The Bill has unanimous support, so I hope there will be no obstacles to it. We did identify two issues, however, around making the Bill work. One was to ensure protection from retaliatory eviction when tenants complain—we thought that important—and the second was access to proper legal and technical advice, which many tenants will need to take on their landlord. We also said that a reformed housing court would make such legal approaches by tenants or anyone else much easier to deal with, and asked the Government to give urgent consideration to that as well.

Lindsay Hoyle: Excellent. It is good to welcome the hon. Member for Sheffield South East (Mr Betts) back to his place.

BACKBENCH BUSINESS

SURGICAL MESH

Lindsay Hoyle: We now come to the Backbench debate on surgical mesh, in which Emma Hardy is to move the motion. As is the custom, she has around 15 minutes. I am sure there could be a little leeway, but Members should be aware we have an important debate to follow.

Emma Hardy: I beg to move,
That this House commends the recent announcement of a retrospective audit into surgical mesh for pelvic organ prolapse and stress urinary incontinence; notes that vaginal mesh has been banned in other jurisdictions such as New Zealand; further notes that NICE guidance recommends against the use of surgical mesh for pelvic organ prolapse and that no NICE recommendations have been made for stress urinary incontinence; notes that Sheffield University recently announced the development of a new mesh material; and calls on the Government to suspend prolapse and incontinence mesh operations while the audit is being carried out, to bring forward the NICE guidelines for mesh in stress related urinary incontinence from 2019 to 2018, and to commit to a full public inquiry into mesh if the audit suggests that this is the best course of action.
I pay tribute to the Backbench Business Committee for enabling this debate to take place and to the fantastic work done by the all-party parliamentary group on surgical mesh implants, of which I am a vice chair, and which is led by my hon. Friend the Member for Pontypridd (Owen Smith). I also thank the hon. Members for East Renfrewshire (Paul Masterton) and for Glasgow North West (Carol Monaghan) for their support in bringing forward this debate, as well as the amazing Kath Sansom and the campaign group Sling the Mesh—many of the women up in the Gallery have done so much to bring this to public attention. It is for the members of this group and everybody else affected by this scandal that I rise to speak today.

Mark Tami: Is my hon. Friend as alarmed as I am—she clearly is—that today and tomorrow women will be having operations that might well cause them complications in the future? Does she agree that these operations should be stopped until we find out the truth?

Emma Hardy: I absolutely agree. One of the main points I wish to make is the urgent need to suspend the use of mesh.
The issue of surgical mesh was brought to my attention by a constituent of mine called Angie, an incredibly brave woman who used to be very fit and healthy, but who, after having incontinence following the birth of her twins and a hysterectomy, was advised to have this mesh operation. She is now unable to work, in constant pain and suffering, cannot take part in sports and has problems sleeping. I remember listening to what she said to me and feeling horrified that this had happened to her. As I have learned, she is most definitely not alone. One story that moved me came in by email this week. The lady who emailed wrote:
“I started noticing that something wasn’t right with me the second day after I was discharged after the operation. It started with my legs—they were extremely stiff and cold, especially my feet, I couldn’t warm them in any way. I rang the hospital, but it didn’t ring an alarm bell to them. Then after a few days, I started having a very bad stomach ache, nausea, headache, chest pain, something happened to my vision, out of the blue, I became very tired and weak, slightly dizzy. I started noticing that I couldn’t focus and think clearly, my scars didn’t heal well and suddenly after a month my biggest scar started producing very smelly discharge.
I requested an appointment with a GP. I was already complaining that something wasn’t right with me. Everything started after the operation…When my health and all symptoms got worse 12 weeks since the operation, I was told that my fatigue is because I have a 2 year old...Now, it’s been 14 months since my operation—I am extremely dizzy and have very poor balance. I can’t feel the ground with my legs. I’m extremely nauseous, I have bad stomach ache, migraines, breathing problems and chest pain. I’m numb. I have vision fog and very painful, sore eyes. My body can’t recognize the temperature. Either I’m too cold or I’m about to faint from the heat. I started having very bad side effects to antibiotics, supplements or even herbal teas. Before the operation, I had no side effects at all. In 8 months, I lost 12% of my total weight and now I’m 8 and a half stone and still losing weight. This mesh wipes my iron out from the system. My fertility is gone.”

Oliver Heald: The hon. Lady is making a very powerful case. Does she agree that one of the most worrying things, and part of the seriousness, is that the people facing decades of pain, suffering and loss of amenity are relatively young?

Emma Hardy: The right hon. and learned Gentleman is completely right, because mesh was given to lots of young women following childbirth—many women were still in their 30s—and it has left them feeling disabled.

Jamie Stone: I am delighted the hon. Lady has this debate. Does she agree that, as well as young women, lots of males are caught in this sorry and ghastly trap? I have personally heard some terrible tales from my constituency, although I will not go into them just now.

Emma Hardy: The hon. Gentleman is absolutely right. After we have moved on from looking at vaginal mesh, we need to look at rectopexy mesh and mesh that has been used in men as well. I completely agree.

Jeff Smith: I congratulate my hon. Friend on her work. The NHS audit recently looked at the women who had suffered as a result. Does she agree that it would have been helpful to look at the number of men who have been affected, so that we get a picture of the true severity?

Emma Hardy: Yes, my hon. Friend is right. The all-party group should push for that after we have looked at the issue.
For those who are more statistically minded, NHS Digital undertook the recent audit, which was published on Tuesday. The facts are these: more than 100,000 women had vaginal mesh inserted between 2008 and 2017 to treat stress urinary incontinence, which is common  after childbirth.

Mark Tami: My hon. Friend mentioned women feeling that they were alone, which is one of the main problems. I have spoken to a lot of people who were told that there was not a problem and that they were perhaps the only ones experiencing a problem. People were on a host of painkillers and were not told that others had experienced the same and that it was a much wider problem.

Emma Hardy: Part of the scandal is how many women were treated when they went back to their doctors. The fantastic work of groups such as Sling the Mesh has brought so many women together, and shown them that they are not alone and that many others have suffered.
The number of subsequent gynaecology out-patient appointments per 100 people having the mesh insertion procedure is 79. There are 43 out-patient appointments per 100 for rehabilitation, physiotherapy and occupational therapy. The figures show that the number of women having the procedure has fallen during the last nine years by 48%, which says an awful lot about what doctors think.
These women were injured. These women were ignored. These women are the victims of a scandal.

Rupa Huq: My hon. Friend is making a very powerful and moving speech. May I include testimony from my constituent, Adele Yemm, from Chiswick? There was a catalogue of errors with her case. She had only mild incontinence, and physiotherapy would have sorted it out. There were issues about consent—she was denied that. She had a full implant fitted. Does my hon. Friend agree that this is the biggest medical scandal since thalidomide?

Emma Hardy: I completely agree that this is an absolute scandal.
During the debate in October, I asked the Government to do four things: to commit to a full, retrospective and mandatory audit of all interventions and, if the data proves it necessary, a full public inquiry; to suspend prolapse and incontinence mesh operations while the audit is carried out; to bring forward the NICE guidelines for mesh in relation to stress-related urinary incontinence from 2019 to 2018; and to commit to raising awareness with doctors and patients alike.
In December, NICE issued new guidance, ruling that the evidence for the long-term effectiveness of the treatment for pelvic organ prolapse is
“inadequate in quality and quantity”.
The NHS is not compelled to act on these guidelines, but that would amount to a de facto ban.
In January, the Government caved in to demands for a national audit of surgical mesh, which reported on Tuesday. The audit is not perfect. For example, it looks only at NHS hospital figures and misses off private patients and out-patients; does not include men; does not include ventral rectopexy mesh sufferers; does not cover visits to GPs; and does not indicate how many times someone has to visit their GP before being referred for out-patient treatment. However, it seems broadly to agree with what we have been saying all along: that the Government’s claim that only 1% to 3% of women suffered serious complications is just not accurate.

Ed Vaizey: I congratulate the hon. Lady on this important debate. She is right to call this a scandal. A constituent of mine now has a colostomy bag and severe internal pain and probably cannot give birth safely in future. She is 24. She makes the point that ventral rectopexy mesh procedures are not included in the audit, apparently because there is no code for surgeons to enter. May I join the hon. Lady in pressing the Minister to go back and include that in the audit so that my constituent’s suffering can be recorded?

Emma Hardy: I absolutely agree, and I hope that will be included in future.
Analysis conducted by Carl Heneghan, professor of evidence-based medicine at the University of Oxford and clinical adviser to the APPG on surgical mesh implants, reveals that the 100,516 women who have undergone mesh surgery in England since 2008 have required follow-up treatment in 993,035 out-patient appointments. He has calculated the total cost to the NHS for all incontinence and out-patient appointments to be £245 million. His analysis of the trend in out-patient appointments also shows that more are required by women as each year passes after their surgery, which is completely the opposite of what you would expect after a successful surgery.
The data shows that the number of operations using mesh has halved over the last decade, which shows that doctors and patients are voting with their feet and telling the world that they do not want to use mesh.

Bob Seely: Will the hon. Lady give way?

Emma Hardy: I will have to continue.
In February came the welcome announcement of the Cumberlege review of how the NHS addresses concerns about vaginal mesh devices and how patients have been treated when raising those concerns. However, I remain deeply concerned that mesh has not yet been completely suspended and that it remains possible for doctors to use it, especially in the case of stress urinary incontinence. There is also still no universally available physiotherapy as standard for all new mothers, as there is in France, to stop these problems before they even arise.
I still believe that it is an absolute scandal that these devices were aggressively marketed to doctors and then used in patients for whom they were unsuited. We need to ensure that lessons are learned and that more steps are taken to make the medical products industry more transparent. Campaigners have even called for legislation, such as they have in America, to require doctors to declare any grants, inducements or scholarships that they receive from the industry.
Some patients think they are having the mesh completely removed, only to find out later that it has been only partially removed. They feel that they are suddenly better and that they are recovering only to go through the horror of having the symptoms come back later. It is important that, where possible, mesh should be removed in full.
Despite the fact that 100 different types of mesh are available in the UK and that we do not know whether just one type is causing the problem or 100 types; despite the fact that Carl Heneghan has raised concerns about the small amount of evidence that mesh manufacturers are required to provide before their products  are approved; and despite the fact that Dr Wael Agur from the University of Glasgow, a one-time advocate of mesh surgery, is now arguing that the Medicines and Healthcare Products Regulatory Agency has only a fraction of the knowledge of the adverse effects associated with mesh, NICE is still not going to bring its guidelines for stress urinary incontinence forward from 2019 to 2018, and the Government seem more focused on process than on the actual product.
Suzy Elneil, consultant urologist at University College London and one of the few qualified surgeons who is able to remove mesh, tells me that she sees 15 women a week who are suffering after mesh surgery. Even if NICE releases its guidance on 1 January 2019, Suzy alone will see another 525 patients before that date— 525 more patients living in unbearable pain. I am sorry, but that is 525 people too many. The Government must press NICE to bring forward the guidelines and pay attention to the product as well as the process.

Bob Seely: Will the hon. Lady give way?

Emma Hardy: I am sorry, but I have to continue.
It seems that our campaign must continue. We must ask again for renewed commitments from the Government to address these problems. Again, I ask the Government to commit to three things. First, we need a full and unequivocal suspension of mesh implant operations. Secondly, I ask them to bring forward the NICE guidelines for stress-related urinary incontinence from 2019 to 2018. Thirdly—this is a new one—will they please offer pelvic floor physiotherapy to all new mums as standard on the NHS, as happens in France, to help restore the core after birth?
I end my speech with exactly the same words I used to conclude my remarks in Westminster Hall. Mesh implants have affected thousands of people all over the country. For some, the consequences of their operation will be life-changing and devastating. A Government commitment to taking these actions will not undo the suffering and pain that these women have endured, but would go a long way to making sure that nothing like this happens again.
This is the second time that I have spoken these words. Let us hope that justice is done before I have to speak them a third time.

Several hon. Members: rose—

Lindsay Hoyle: Order. The time limit for speeches is eight minutes.

Sarah Wollaston: I pay tribute to the many women, including those in my constituency, who have come forward to discuss deeply personal and painful accounts of serious complications following mesh surgery, sometimes with life-changing and lifelong consequences for them and their families. I also thank the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) who, as always, has set out the background to the issue so eloquently. She has been such a campaigner on behalf of victims, and I really thank her for what she is doing. I will not repeat much of the background that she set out, but I will highlight a few points to which I hope the Minister will respond in her closing remarks.
As we have heard, NHS Digital has published a review of patients who have undergone urogynaecological procedures for prolapse or stress urinary incontinence, including those where mesh, tape or equivalents were used. However, as the hon. Lady pointed out, the review does not cover all procedures, nor does it include the men who have been affected. We know that 100,516 women underwent these procedures between 2008 and 2016, of which 27,016 cases involved mesh for prolapse. Although the numbers are falling, I am afraid that this is just a snapshot.

Bob Seely: I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on calling this important debate. Are the figures accurate? I have been told that some of the figures do not include people who are treated abroad and come here having developed complications, or people who have been to private clinics. The numbers that we have may therefore not be accurate, perhaps underestimating the true total.

Sarah Wollaston: I was about to come to that very point. Crucially, many of the women I have met have been treated in the private sector. In this House, we should be concerned about all our constituents, not only those who are treated in the NHS. Of course, it is the NHS that often then bears the burden of managing complications, but we must have a much more accurate picture.
I support the call from the Royal College of Obstetricians and Gynaecologists and from the British Society of Urogynaecology for mandatory prospective data collection, using the BSU’s database. That is a well-established method of collecting outcome data. Retrospective snapshots are no substitute for collecting data as we go forward or, most importantly, for being able to track it in the long term. Although the majority of complications that happen after 30 days happen in the first year, many of the women I have met developed complications far later than that. I particularly want to emphasise to the Minister how important it is that we have access to shared databases not just here in the UK, but across Europe. Will the Minister tell us whether the Government will be seeking for us to remain part of the European Database on Medical Devices—EUDAMED—so that we not only get an accurate picture of what is happening here in the UK, where our population is smaller, but can compare our data with the whole European Union?
That brings me to the wider point about Brexit that is highlighted in the report of the Select Committee on Health on the implications of Brexit on medicines, devices and substances of human origin: the issue of access to clinical trials. It is encouraging that the Government have stated that they wish to remain a part of the European Medicines Agency or to have associate membership, but there are all sorts of aspects to forward clinical research on which it is essential that the Government campaign. They must campaign not just to maintain regulatory alignment and harmonisation, but to ensure that we can remain part of all research mechanisms and mechanisms for ensuring that we have the earliest possible awareness of any complications—not just from drugs but, as this situation has shown, from medical devices. I hope that the Minister will further outline the Government’s intention in that regard.

Oliver Heald: My hon. Friend will remember that I spoke about my constituents in Letchworth during the debate in Westminster Hall. I am delighted that the audit has been done, but another constituent from Letchworth has been in touch with me since then. She has had ventral mesh rectopexy surgery and posterior mesh rectopexy surgery, which I understand are subsets of the mesh cases. Does my hon. Friend agree that if we were to look at a smaller group of people such as her across Europe, we would actually get quite a good picture of what is happening, given that we would be looking at data across a bigger area?

Sarah Wollaston: My right hon. and learned Friend is absolutely right, and his point applies not only to medical devices. When it comes to relatively rare conditions, we need to look at the widest possible population base in order to detect any complications. It is also important to use the widest possible population base when detecting rare complications. I thank him for highlighting that.
If we are to have informed consent for women, it has to be based on high-quality, balanced and evidence-based information, and that has been lacking. We also need to be clear that if a medical device is altered in any way, it must be part of a clinical trial. That was entirely lacking in this situation. The types of device, including the size and thickness, were changed without anyone properly recording or following up on those changes. That has to be the key lesson for the future.

Owen Smith: The hon. Lady is making an extremely important point. Does she agree that the issue here is that all one effectively has to prove for a follow-on device is its equivalence with the original device? There is therefore a fundamental flaw in how we license devices versus the far more rigorous way in which, for example, we license molecules.

Sarah Wollaston: I absolutely agree. It strikes me that there has been a kind of wild west out there, with representatives saying, “Why don’t you try this one? This is probably going to be better”, without organisations setting up clinical trials from the start so that we could compare different devices, and without women giving properly informed consent that a different kind of device would be used. Lessons have to be learned not just for mesh surgery, but for other medical devices. Just because something sounds like it might be better, it does not mean to say that there will not be serious complications. Those complications may also happen at a late stage. We need databases such as EUDAMED so that we have access to the widest possible population base and clear device tracking.

Mark Tami: Does the hon. Lady agree that many women were told that this was like a miracle cure—a very quick fix—and were not given all the facts about it?

Sarah Wollaston: I do agree.
As I say, informed consent is essential, and that was lacking in very many cases. There are cavalier attitudes and assumptions that medical devices are somehow safer than medicines, but we know that that is simply not the case. We have to rigorously make sure that devices are all part of clinical trials, with long-term follow-up and tracking. Perhaps the Minister could  update us on how we are getting on with the barcoding of devices, which clearly makes them over time. One of the tragedies is that many women are completely unaware that they have even had mesh inserted at all. That, again, has to be a lesson that we learn for the future about accurate documentation.
I hope that the Minister will comment on whether there are plans to introduce compensation for victims. As I said, many of the women I have met have had profound, life-changing injuries, and many are entitled to compensation.

Rupa Huq: The hon. Lady mentions the physical injuries and physical pain, but does she agree that these women have also had great emotional pain and psychological suffering? Many are suicidal. The Minister would be well advised to introduce, within a future action plan, counselling services of some kind for these sufferers.

Sarah Wollaston: I thank the hon. Lady for making that point. Yes, absolutely: the scars have been profound not only in physical terms but in the impact on how people feel about themselves. There is a great impact not only on them but on their families and their relationships.
On access to services, while we all welcome a tertiary service being set up for victims of urogynaecological mesh, there is concern about current waiting times for those who wish to have a referral to a tertiary centre, and about access to investigations, which need to be timely. When women come forward to report deeply personal and distressing experiences, it is important that they can be seen as rapidly as possible. I hope that the Minister will comment on that.

Owen Smith: I congratulate my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing today’s debate. This is the first occasion on which we have debated this issue on the Floor of the House—in the main Chamber—and it is a very important moment in the campaign.
I thank and congratulate all the women who have been campaigning on this issue, long before it was raised by any of us in Parliament—particularly the indefatigable Kath Samson, who has led the Sling the Mesh campaign quite brilliantly in recent years and made this such a salient issue in the media, and now in Parliament. From a personal perspective, I very much thank my own constituent, Carolyn Churchill, who came to see me about this issue several years ago and revealed to me the scale of the suffering and trauma—life-changing trauma—that she had experienced as a result of having mesh implanted. We campaigned to have her mesh removed, and that has been life-changing for her. I am delighted to see her with us today in the Gallery.
It would be easy to be extremely angry and passionate about this, but I do not want to do that today, nor do I want to list the many life-changing, debilitating ways in which people have been affected. I am sure that many other Members will speak about that. I want to speak a little more dispassionately about how we have got to where we are, the history of mesh, and some of the wider lessons. While this is a tragedy for individuals, it is clear, as the hon. Member for Totnes (Dr Wollaston)  highlighted, that it also speaks to deep, substantive issues not just about mesh but about licensing, monitoring and the diffusion of devices into the health marketplace more generally.
So what is the history of mesh? Mesh was introduced in the 1970s, and withdrawn because it was not felt to be an effective way of addressing issues and because many doctors felt that there were too many side effects associated with it. Like many devices, it was then improved marginally, and it was reintroduced in the late ’90s and early 2000s. As my hon. Friend the Member for Kingston upon Hull West and Hessle said, it was marketed incredibly aggressively among doctors because it was perceived as being quick and easy—day case keyhole surgery as opposed to much the more invasive, difficult and costly means of treating stress-related urinary incontinence, in particular, through colposuspension and autologous sling, using individuals’ own tissue to raise the bladder to deal with incontinence.
One understands why, in that set of circumstances where mesh was seen as safe and effective, doctors picked it up in huge numbers. In 2008-09, 14,000 women had an implant—the high point, as it were, of the usage of mesh. As my hon. Friend said, we have seen a general decline in usage over a period. Throughout that period, the Medicines and Healthcare Products Regulatory Agency, the National Institute for Health and Care Excellence, the royal colleges and Ministers in this place and elsewhere have said, in effect, that it is safe, with side effects in only 1% to 3% of patients—perhaps 3% to 5%, they have conceded on occasion, but still relatively small numbers and arguably, they say, within the bounds of acceptability for surgery.

Bambos Charalambous: Does my hon. Friend agree that had doctors not sold mesh aggressively to women, many women may not have chosen it as a way of solving their problems and may not have had the problems and complications they have now?

Owen Smith: Yes. The long and the short of it is that this has become such a widespread problem because younger women, in particular, were told by their doctor that there was a quick and easy way in which a minor inconvenience for many women—although a major inconvenience for some—could be dealt with.
Clearly, the scale of the side-effects was not apparent, for all the reasons my hon. Friend the Member for Kingston upon Hull West and Hessle listed, but notably because there is no long-term trials data in respect of devices. The sorts of complications that we now see emerge over a long period. That is why, in our country and across the world, such widespread concern about mesh has been emerging in every health market.

Mark Tami: My hon. Friend mentioned removal of mesh. Does he agree that there should have been a lot more research about how easy it is to remove, because it is actually very difficult and only a few surgeons will undertake that work?

Owen Smith: My hon. Friend is right. The whole point of mesh is that it is designed to induce scar tissue in order to fuse the mesh with the muscle, and therefore trying to excise the mesh is incredibly difficult. That is  why there are partial removals and some women are left with pieces of mesh inside them, even after surgery. Those sorts of complications are clearly very worrying. They ought to have been explained properly to women, but obviously were not, in very many cases.

Julian Lewis: The hon. Gentleman is making an excellent speech, and I thank him for his work. Will he go back to what he said a few moments ago about the idea of it being acceptable that 1% to 3% of cases might go wrong? It might be acceptable if we are dealing with a small overall total, but when we are dealing with over 100,000 cases, we are saying that it is acceptable for 1,000 to 3,000 people to suffer devastating, life-changing injuries as a result of this procedure. Surely that is anything but acceptable.

Owen Smith: It absolutely is not acceptable. I hope that the Minister is not going to repeat what other Ministers have said in written statements and in this place, which is that 1% to 3% is the sort of failure rate, or complication rate, that one would expect with all sorts of surgery. The reality is that the numbers are far greater than that—far, far greater—as the audit this week shows. I will come on to address that.

Lloyd Russell-Moyle: Does my hon. Friend share my concern that some hospitals are still advertising low failure rates, particularly for tape? That disguises the issue, particularly when they refer to failure rates in the first year and do not talk about long-term studies.

Owen Smith: Yes. We have heard that many women have this undertaken in private clinics—perhaps half of them, although we do not know how many that means. Those clinics advertise success rates very widely; we can find it all over the internet. The fact that this is described as mesh, sling, tape or ways to uplift the bladder obfuscates what we are really talking about and makes it difficult for women—and indeed, I suspect, occasionally doctors—to know the nature of what they are dealing with. What has emerged, as evidence has come through, is that there are greater problems than was appreciated. That is why, given that mesh was originally licensed to treat stress-related urinary incontinence and then extended to pelvic organ prolapse, we should be deeply concerned that mesh is already effectively banned in our country for pelvic organ prolapse—that happened just last year. It is now to be used in research only, which is tantamount to a ban. That is happening in countries all over the world—just last year New Zealand effectively banned mesh for both SUI and POP, although I gather it may lift the ban in future. This is a worldwide problem.
We have had the audit results this week. Let us be clear that we only had an audit because of the great campaigning by Sling the Mesh, the APPG and other bodies. We asked Ministers directly to conduct it, they were good enough to do so, and I am pleased they have. The results show that far from there being just a 1% to 3% occurrence of serious complications, there is a 4% rate for complete removal of mesh. Five hundred and fifty out of the 14,000 women who were given mesh in 2008, the first year of the study, have had it removed at some point in the last decade. That is not rates of complications  such as pain or sexual dysfunction: the mesh is so problematic that women have had to go back under the knife to have it cut out.
As for the complications, which the audit has tried  to measure by looking at the volume of outpatient appointments, the 100,000 women who have had  mesh inserted have needed almost 1 million outpatient appointments. They have gone to their GP to say they have a problem and been referred to a consultant for an outpatient appointment, whether for pain management, residual gynaecological problems or some other problem—trauma, in some instances. That must be indicative of the scale of the problem and the cost to the NHS, as illustrated by the work done for the APPG by Carl Heneghan. Some £250 million may have been spent in a decade to sort out the problems.
Mesh is a much bigger problem than has been appreciated by the clinical community, which has been incredibly defensive in dealing with it. The community must be much more open and honest about it. We have to address the issues of licensing: it cannot be enough for follow-on devices to only have to prove equivalence, or for a registry to be run simply by the royal colleges, which have been resistant in the past to having a registry. We should have a standardised process to put a registry in place to follow patients. Crucially, NICE must also get its act together. Why have we waited three years for NICE to bring forward new guidelines? It is still saying that that will not happen until next year—it needs to be done this year. This issue needs to be dealt with tomorrow.

Fiona Bruce: I echo the comments of many hon. Members and express my deep concern for all women who have experienced debilitating and sometimes severe pain and discomfort following the use of vaginal mesh. In all our considerations of the use of such devices, their health, safety and wellbeing must be our first concern.
I welcome the Government’s recent announcements of Baroness Cumberlege’s review of the use of vaginal mesh and two other areas of medical safety—the use of valproate and Primodos. I was in the Chamber when the Secretary of State for Health announced that review on 21 February and I could tell from the tone of his announcement, not just the content, that he personally cares very greatly about the women affected by this issue. He wants to ensure that lessons are learned wherever possible, so that care can improve to ensure that each woman gets the treatment that is right for her—the best that can be provided for her as an individual. I am sure that the Minister shares that view.
The Secretary of State said:
“It is an essential principle of patient safety that the regulatory environment gives sufficient voice to legitimate concerns reported by patients, families and campaigners, works alongside them and responds in a rapid, open and compassionate way to resolve issues when these are raised.”—[Official Report, 21 February 2018; Vol. 636, c. 166.]
Ministers want to ensure that we do better in future where necessary, and to ensure that patient voices are brought to the table. I support the review and I want to ensure that justice is done for all women who have concerns about the use of vaginal mesh. We need to ensure that we maintain public confidence.

Chris Elmore: On the hon. Lady’s comments about justice being done, I have been approached by two constituents who have been greatly affected by vaginal mesh. One of them is unable to work. She has to be lifted up to walk as she cannot stand by herself, so she needs carers. Does the hon. Lady agree that in many cases it is not only justice that is needed, but compensation? As the Chair of the Health Committee said, we need to start looking at compensation for some women. My constituent is in her early 50s and can no longer work.

Fiona Bruce: That is something that I have said not only about this issue, but about the use of valproate. It is important that we pay close attention to the experiences and difficulties that patients have endured. We need to be more open to learning what we can from their experiences, making changes where necessary and—as the hon. Gentleman says—examining where compensation should be sought for them.
Baroness Cumberlege has been instructed to look comprehensively at the whole issue. The Government want to listen. We have all seen examples in which people have appeared to listen to concerns, nodded their heads and then gone away and done nothing. That is not what is happening here. I believe that the Secretary of State and Ministers not only want to listen carefully to concerns on this issue, but stand ready to act appropriately. For that reason, I think the proposal in the motion for a full public inquiry is inappropriate at this stage. We need to give time for Baroness Cumberlege to report. We need to urge that that be done urgently, and we need to ask Ministers questions.
I have some questions of my own for the Minister. What is the timescale for the review and what progress has been made already? Does the Minister agree that introducing an outright ban would be inappropriate before the review? Can she assure the House that the new NICE guidelines which recommend against first use of the surgical mesh to treat pelvic organ prolapse are being carefully followed throughout the NHS? Is it correct that in the vast majority of instances the use of surgical mesh has proven to be an effective intervention that has enabled many women to live happily and independently after surgery? I believe that some 1,500 women receive vaginal mesh implants each year and the majority respond well. If that is correct, it is important to balance that against the distressing individual cases that we have heard about today. I also understand that the high rate of success for the use of surgical mesh to treat hernias suggests that an outright ban would be rash at this stage, and certainly premature before the Cumberlege review reports.
What information can the Minister provide on the recent development of a new material for surgical mesh implants? What more information do we have about how that is expected to reduce discomfort because of its greater likeness to human tissue? Can the Minister update the House on what progress is being made to improve GPs’ awareness of SUI and POP and how best to treat those conditions, so that women are given the most appropriate treatment for their circumstances? Will the Cumberlege review take into account international research on this issue? We have heard some mention of it today, but I understand that no other jurisdiction has imposed an outright ban on the use of mesh.
In conclusion, the Secretary of State has made it clear that we are building on substantial work from over the past few years—the Cumberlege report comes on the back of a lot of other work, and I hope the Minister will confirm that that will all be taken into account. I ask Members to await that report before we make any final decision. Professor Keith Willett brought forward the 2017 Mesh Oversight Group report, which followed the Mesh Working Group interim report in 2015. He said that
“there has been significant progress since this work began. Information available to women and clinicians is now better and more consistent, data recording has been improved, including of complications, and women can now be referred to multi-disciplinary teams of health professionals with the experience necessary to advise women who are experiencing complications from mesh surgery on their treatment options.”
John Wilkinson, Director of Devices at the Medicines and Healthcare Products Regulatory Agency, stated:
“We continue to see that evidence supports the use of these devices in the UK for treatment of the distressing conditions of incontinence and organ prolapse in appropriate circumstances.”
We must ensure through this review that every circumstance in which these devices are used is appropriate, and that the women involved feel confident of that.

Patrick Grady: I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing the debate through the Backbench Business Committee. I took part in a powerful debate on the issue in Westminster Hall, and I am delighted that time has now been made available on the Floor of the House. I commend all those involved with the Sling the Mesh campaign and the all-party group, and I commend the hon. Member for Pontypridd (Owen Smith) for the leadership he has shown. This issue is finally getting the attention that it deserves. Like most Members, it was brought to my attention by a constituent who has been affected first hand, and I wish to reflect on some of the experiences and points that she shared with me, as well as considering broader policy issues on which I hope the Minister will respond.
Other Members have already mentioned ventral mesh rectopexy, which has not been included in the UK Government’s proposed audit. Sling the Mesh’s campaign research shows that 7% of its members have been affected by that specific procedure, and there is a certain amount of disappointment that it does not seem to have been included. As the Minister might know, I have written to the Secretary of State about that concern, and asked the Government to think again, particularly given the number of people affected and the devastating effect that this has had on their lives.
I also raised concerns about the need for a hospital episodes code to be allocated to that procedure. Without one, it is difficult to keep track of the number of people affected, and we have already heard about the problems arising from the lack of information about the exact number of people affected by the procedure and the mesh more generally.
There are also concerns that some recent National Institute for Health and Care Excellence guidelines might have been rushed through, partly in response to  media attention, which only adds to the argument for a full and comprehensive audit that includes all types of mesh procedure.
The health service is devolved in Scotland, where there is a slightly different situation. In 2014, the Scottish Government requested a suspension in the use of medical mesh by the NHS in Scotland pending safety investigations, and in 2015 the Cabinet Secretary for Health, Wellbeing and Sport, Shona Robison, apologised to women who had been left in severe pain by such operations. Between 2009 and 2016, the number of women receiving mesh surgery in Scotland fell from 2,267 to just 135.
An independent review published in March last year in Scotland made eight recommendations, notably that surgical mesh implants should be used only after all other appropriate alternatives have been exhausted, and—crucially—only when women have given their fully informed consent. Scotland’s chief medical officer accepted the recommendations of that report in full, and has been clear that the requested suspension in the use of mesh implants should remain in place until she is satisfied that all recommendations have been implemented. That means that all women in Scotland who want treatment for urinary incontinence or pelvic organ prolapse should be offered the full range of options available, and they should be fully informed of the benefits and risks associated with those procedures.
Regulation of these devices is reserved, however, and operates at UK-wide level, which is why calls for a UK-wide national clinical audit and database for recording device identifiers are so important. Scottish Government officials are working with UK colleagues to consider the possibility of an automated implant registry, which would allow unique device identifiers to be entered on the patient’s electronic record. As the Minister will know, the now Cabinet Secretary for Health and Sport has written to the Health Secretary to suggest a UK-wide woman’s health summit. That would allow the NHS, and relevant decision makers across the United Kingdom, to work constructively on a range of issues.
I wish to raise other aspects of regulation, and particularly EU regulation on medical devices 2017/745. That will change mesh implants for long-term or permanent use from a class IIB to a class III device, meaning that they are generally regarded as high risk. The regulations will not take full effect until 2020, which is after the Government’s preferred date for Brexit. How will important EU regulations that monitor the use of devices across EU territories be implemented or reflected in UK law and regulation after Brexit? It is important that standards are maintained to the highest possible level.
Campaigners such as my constituent are concerned about the current process of what could be called post-market vigilance, and whether some of the devices are subject to testing that is rigorous enough before they are rolled out to the market. There is a genuine concern that device manufacturers have a profit motive to develop their devices and get them on the market as quickly as possible, although equally, they have a fear of litigation, which is why better and stronger regulation from the start is key.
The risks associated with surgical mesh implants were tragically misunderstood and underestimated by healthcare providers and professionals who provided  the treatment, and by patients whose lives have been so badly affected by chronic and debilitating pain. I welcome the conclusions and recommendations of the Scottish and English reviews of this procedure, which must ensure that surgical mesh implants are used only after all other appropriate alternatives have been exhausted and—crucially—only when women have given their fully informed consent.
I hope that Ministers will be willing to work with their counterparts in the devolved Administrations and consider a UK-wide summit on the issue and women’s health more generally. I will finish as I started by paying tribute to my constituent and all campaigners for their bravery and courage in ensuring that this issue has been brought to our attention. It is them we must thank for the small and belated progress that has already been made, and for them we must continue to hope for more and faster progress in future.

Julian Lewis: I start by saying that I think the steps taken in Scotland, as described by the hon. Member for Glasgow North (Patrick Grady), sound extremely sensible as interim measures until final decisions can be taken. I echo the thanks due to the hon. Members for Kingston upon Hull West and Hessle (Emma Hardy) and for Pontypridd (Owen Smith), their associates in the all-party group, and Sling the Mesh campaigners. I also thank my three constituents, Emma, Eileen and Helen, who have all shared with me their harrowing experiences of the procedure.
There is no doubt that when vaginal mesh procedures go wrong, the results can be truly catastrophic. A letter from the Minister states clearly that
“women have suffered atrocious and debilitating complications”
from these implants. Her counterpart in the Upper House, Lord O’Shaughnessy, has conceded this:
“While these treatments can be effective, in a small minority of cases meshes can cause serious long-term injury and disability, and prevent or reduce the ability of affected women to work.”
According to a letter from the Health Secretary to parliamentary colleagues in February:
“Clinical experts here and abroad agree that, when used appropriately, many women gain benefit from this intervention, and hence a full ban is not the right answer.”
I find it difficult to follow that logic. There might be an acceptable argument if we were talking about a procedure in which the numbers of interventions were in the hundreds, but, as I said in an intervention and as the hon. Member for Pontypridd (Owen Smith) endorsed, we are talking here about over 100,000 people. When we are talking about over 100,000 people, if even the Government’s low figures of 1% to 3% going badly wrong are right, that is still 1,000 to 3,000 people. I have been given, by my constituent Emma, a leaflet from Sling the Mesh that says that its estimate is that at least 15% of people are seriously and badly affected. On that scale, we are talking about over 15,000 people being seriously damaged by this procedure.

Owen Smith: I thank the right hon. Gentleman for giving way and for his kind remarks. Would he be surprised to learn that the chief medical officer, Dame Sally Davies, speaking alongside the Health Secretary  in a Facebook Live broadcast just a few months ago, said that she thought the serious complication rate was between 15% and 20%? I have written to her asking where she got those numbers, although as far as I am aware she has not replied to me, because that is at odds with all the previous comments by Ministers and officials.

Julian Lewis: Indeed. I would be surprised at that, because if that is what Dame Sally believes she ought to be making different recommendations.
I have been given a particular study, which is described as the largest study of surgical mesh insertions for stress urinary incontinence. Over 92,000 women were surveyed in this particular examination, including all NHS patients in England over an eight-year period. The conclusion states:
“We estimate that 9.8% of patients undergoing surgical mesh insertion for SUI experienced a complication peri-procedurally within 30 days or within five years of the initial mesh insertion procedure. This is likely a lower estimate of the true incidence.”
I reiterate my point about acceptable and unacceptable percentages. When we are talking about these very large numbers, even relatively low percentages make the procedure too risky to be used in anything other than last-resort circumstances similar to those described by the hon. Member for Glasgow North.
In the past decade, my constituent Emma has undergone X-ray-guided injections, ultrasound scans, MRI scans, in-patient stays, tests galore, more and more scans, and, eventually, a biopsy. She has been refused referral to a mesh specialist centre. It seems highly likely that she should never have been given a mesh implant in the first place after the trauma of such a difficult birth, which leads me to the next point about inadequate warnings. I understand from my constituents that they were given little warning, and in many cases no warning at all, about the potential dangers.

Kevin Hollinrake: My right hon. Friend is making some very important points. Does he agree that prevention is better than cure? If physiotherapy was offered to women after childbirth, that might obviate the need for any surgery at all as a result of these kinds of complication.

Julian Lewis: Indeed. The problem with this issue, as it has been impressed on me at any rate, is that this has been put forward as a quick-fix alternative to other procedures, whether surgical or not, which would take much longer.
Having paid thousands of pounds for private specialist assessment, in the end Emma eventually managed to get the sort of referral she wanted. I have been given the following clinical summary of her condition:
“Vaginal mesh; foreign body giant cell reaction, chronic inflammation and fibrosis.”
I have a page here that lists some 50 different symptoms related to implant illness and foreign body giant cell reaction. I venture to suggest that if this ghastly catalogue of things that could go wrong had been shown in advance to those 100,000-plus women who have had a mesh implant, more than 90% of them at least would have turned it down.
This is what my constituent Eileen wrote to me:
“The effect that this has had and is still having on my life is massive. I can no longer carry out basic tasks at home or do things with my children due to the pain. I need to take medication   every day from my GP to try and ease the pain. I cannot go to work at present due to the pain and I am currently on sickness absence leave from my job. The mesh implant that I have had has and is continuing to destroy my life. I need an operation to remove the mesh implant, but the operation is very complex and unfortunately there are limited amounts of surgeons who are experts in the full removal of these mesh implants. Due to my financial situation, I am not in a position to be able to afford to have the full removal of the mesh implant done privately and therefore I am having to wait for this to be done on the NHS which is taking far too long.”
I turn now to Helen, who probably has the most horrifying story of the lot. She was 35 when given what was described to her as routine surgery 16 tortured years ago. She was initially told that it was her fault that her body was rejecting the two mesh implants. She then went through a cycle of implants, the removal of protrusions and eroded segments and seven bouts of surgery. Three TVTs—trans-vaginal tapes—are still inside her, she suffers chronic pain from orbital nerve damage, constantly needs painkillers and has had constant side effects, indifferent treatment and a refusal to admit fault or to refer her to an out-of-area specialist in mesh removal. She writes:
“I do not want anyone from the hospital coming near me ever again. I have lost complete faith in them. I have been lied to and told repeatedly it was my body rejecting the mesh; but, unbelievably, they kept putting more in.”
She suffers from truly terrible bowel problems, some no doubt caused by the side effects of the painkillers and the sleep aids she has to take. Consequently, she suffers from depression, loss of confidence and lack of self-esteem. She further writes:
“I feel let down by professionals who were supposed to treat me to the best of their ability. There has been information about the adverse effects of mesh around for years, yet these doctors are still happily inserting them into thousands of women.”
She is desperate to be referred to one of the few doctors who specialise in mesh removal and feels trapped under the control of the very people who have let her down. She continues:
“I want these devices out of my body.”
Who can blame her?
Let me conclude by quoting, from an article in The Daily Telegraph of 23 October last year, a lady who suffered for eight years:
“I just wish I had never, ever had it done. I would rather have coped with that very minor problem of stress incontinence than this. If I had known even one of the possible risks of the surgery there is no way I would have had it done. I am furious that I was never told that this could happen.”

Fiona Onasanya: I thank my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this debate, which is of paramount importance. I have listened to the contributions from Members on both sides of the House. I was struck by the comments made by the hon. Member for Congleton (Fiona Bruce), who said she felt that we could not say now that the use of surgical mesh should be suspended. I have been brought up to think that if it has four legs, eats grass, produces milk and moos, it is not a fish. If we are hearing from the women who have had the mesh implants that they are not working, that they have destroyed their lives and that  they have debilitating painful consequences, why on earth would we try to justify not suspending the use of this mesh? It is horrendous.
On 21 March, I asked the Prime Minister about surgical mesh. She advised in her letter of 28 March that the Medicines and Healthcare Products Regulatory Agency review concludes that the benefits of vaginal mesh implants outweigh the risks. How can this be? How can it be that people who have gone in for a day’s surgery and come out thinking, “My life’s going to be better—I can rock climb, mountain bike and run with my kids,” find that they cannot move and are in constant pain? Some constituents who have contacted me are reduced to being in wheelchairs. How can we possibly say that the benefits outweigh the risks? It is horrendous.
Furthermore, according to both the NHS and the MHRA, the risk of vaginal mesh complications after an implant is stated as being between 1% and 3%. However, as other Members have mentioned, a recent study for Nature Research found that 9.8% of people suffered complications within five years of surgery. The Sling the Mesh Facebook page has over 6,000 members. The numbers do not add up: more people are suffering from the mesh complication than are credited in the statistics.
Even former surgeons such as Dr Peter Jones have declared that they would not take the risk of using mesh. A survey by Sling the Mesh found that over 60% of patients are suffering from anxiety and depression. I therefore urge the Minister not to risk more women having their lives blighted. We have heard that mesh can shrink, degrade and twist in a woman’s body—I put that to the Prime Minister in my question—and we now know that women have been left in permanent pain, unable to walk and unable to work because of the procedure.
I would argue that, due to the limited remit of the audit in the Government’s “Retrospective Review of Surgery for Vaginal Prolapse and Stress Urinary Incontinence using Tape or Mesh”, many women have been missed, which is why the stats do not stack up. Women who for years have gone back and forth to their GP for pain relief or antibiotics and have then become resistant to the antibiotics, women who have been treated in the last 12 months, and women who have not yet been referred have been overlooked. An urgent public inquiry must be undertaken into the number of women adversely affected and why the safety of so many has been disregarded.
We have heard about Kath Sansom, the founder of the Sling the Mesh UK campaign, who is in the Public Gallery. She said that she
“lost hope for the future”
when she underwent the surgery. She ran a poll of 500 women, and 83% said that they had not been fully informed of the risks. People have the right to make an informed choice and the right to receive the information and understand the implications of undertaking the procedure.
Furthermore, 70% reported having lost their sex lives and that they are still facing adverse events as late as 18 years after the procedure. These events include debilitating pain in the groin, pelvis and legs, as well as  infection and inflammation. People are basically not able to conduct their usual business, such as playing with their children or going mountain biking, as I mentioned, and it is not fair. Most women in Kath’s support group added that they do not feel there is any aftercare following the implant procedure. That ties into the availability of information and the ability to make an informed choice.
Despite the recommendations from the NHS England report, less than 27% of clinicians have reported on these adverse events. Private hospitals are not audited for adverse events. Worse still, doctors who have been struck off by the General Medical Council are still able to work in these institutions. That is unacceptable.
Under the US Physician Payments Sunshine Act 2010, manufacturers must submit annual data on payment and transfers of value made to covered recipients. Several studies have been carried out by organisations with shares in mesh manufacturers. Similar legislation designed to increase the transparency of financial relationships between physicians, teaching hospitals and manufacturers of drugs, medical devices and biologics is required in this country. We need to understand what the kickback is. If someone is being asked the question, “Do you think mesh is good?” and have investments in mesh, why would they say no? We need to be more transparent and understand what these women are going through.
These sequential calamities must each be understood and corrected so that they are not repeated. Those who have suffered and faced complications must be referred via their GP to a specialist unit with multidisciplinary teams of professionals who can listen—not just hear what they are saying, but listen and understand what they are going through—advise and support them, and ensure that no more patients are harmed. I urge the Government to suspend the use of surgical mesh and tape for all procedures.

Paul Masterton: I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this debate. Although we went in front of the Backbench Business Committee together, the truth is that she did most of the work. I am hugely grateful for what she has done in this space. Having set herself a very high bar with the way in which she opened the Westminster Hall debate in October, I can safely say that mesh-injured women in Scotland will be incredibly grateful for the support that she has shown them through her remarks today.
In the six months since that debate, there have  been a number of important developments both  internationally and domestically. There have been landmark announcements in Australia and New Zealand, as other hon. Members have mentioned. While the UK Government have so far not chosen to take similar action here, I will certainly continue my efforts with the all-party group on surgical mesh implants to persuade them that banning mesh is the right thing to do, particularly now that the National Institute for Health and Care Excellence has issued guidance that favours an effective ban in practice.
There was a Public Petitions Committee debate in the Scottish Parliament just before Christmas—as I set out at our previous Westminster Hall debate, the Scottish Mesh Survivors group was left with very little option but to continue its fight through the Scottish Parliament  Public Petitions Committee following a hugely disappointing report from an independent review group established by the Scottish Government. A further review exercise is currently progressing in Scotland. However, it will not re-evaluate the conclusions of the independent review—it will assess only the merits of the process by which those conclusions were reached, so it has the potential to undermine that flawed exercise even further.
At this stage, I pay tribute to the three amigos in the Scottish Parliament: my Conservative colleague Jackson Carlaw, Labour’s Neil Findlay, and the Scottish National party’s Alex Neil, the former Cabinet Secretary for Health and Wellbeing. All three immediately recognised that there was a serious issue to be investigated and continue to champion mesh-injured women across Scotland, such as my constituents Elaine Holmes and Lorna Farrell.
One of the big difficulties is that it has been very hard to get media uptake, particularly in Holyrood with the male-dominated press lobby. They found it a bit icky and did not want to write about it, so I pay tribute to Marion Scott, a journalist who has been absolutely dogged in her determination to highlight this issue, and to the hon. Member for Pontypridd (Owen Smith), who has gone out of his way to make sure that it gets pushed up in the media across the rest of the UK, giving it exposure that it would have otherwise been very difficult to achieve.
In February, the Secretary of State for Health and Social Care outlined a number of important measures to review mesh and investigate what had gone wrong. It is fair to say that a lot of the campaign groups found the overall package slightly underwhelming, but it is vital that their input into the process is given the utmost attention. Of course, this week the retrospective audit was published.
As has been said, it is right that the Health Minister, Lord O’Shaughnessy, has instructed the chief medical officer in England to respond to the findings with some urgency following engagement with the medical authorities and, importantly, with the patient groups representing women whose lives have been wrecked by mesh. Too often when there have been statements, guidance and responses, the views and experiences of these women have been completely ignored. They have been talked about as though they are not there. Their experiences have been undermined and dampened down, so if patient groups are to have any faith in the UK Government, it is important that patient voices are front and centre of the process.
I was particularly pleased when the Secretary of State announced to the House that £1.1 million would be provided for the establishment of a comprehensive mesh database. That is a positive development, and mesh-injured women in Scotland have reacted warmly to it, but they have also made it clear that, if the authorities are to gain a true picture of the suffering that mesh can cause, it must be accompanied by a requirement for mandatory reporting of all mesh procedures. Crucially, as a number of others have said, that must encompass not just NHS but private procedures, because many of the women concerned were treated privately. If mandatory reporting is not already envisaged, I urge the Department to explore that possibility.
The setting up of a database in Scotland was one of the six points included in the petition that Scottish  Mesh Survivors brought to the Scottish Parliament in 2014 and 2017. It is fair to say that progress has been pitiful, and it was therefore welcome that the Secretary of State made clear that he was open to the idea of a UK-wide database and to working closely with the devolved Administrations with the aim of establishing a clear UK-wide picture. Along with my hon. Friend the Member for Angus (Kirstene Hair), I wrote to the Scottish Government Cabinet Secretary for Health and Sport about the database, and was pleased when she confirmed that her officials had been liaising with colleagues at Westminster and the other devolved Administrations. Perhaps the Minister will explain exactly how those communications will proceed.
In view of the failure in Scotland to proceed with a database in the four years since the survivors’ petition was first brought to Holyrood, Scottish involvement in the issue of a UK-wide database—

Philippa Whitford: Is the hon. Gentleman aware that the discussion in Scotland was about the need for the database to be UK-wide? We have talked about EU registration. The bigger a population, the sooner a problem is noticed. The Medicines and Healthcare Products Regulatory Agency is UK-wide. It is not a question of small databases. The Scottish Government were not obstructing the proposal. The profession felt that the database needed to be UK-wide, and needed to feed into the MHRA.

Paul Masterton: I certainly agree that a UK-wide database will be far more effective and beneficial in providing a true representation of the story of the mesh-injured women, but the hon. Lady must accept that the women in Scotland have found the response of the Scottish Government—and, in particular, that of the current Cabinet Secretary—fairly poor.
A lot has happened in the past six months, both at home and abroad. Some progress has been made, and important steps have been taken, but we have much further to go. Members of Parliament are often asked, “What do you want to achieve in this place? What tangible thing do you want to walk away from here and say that you have done?” Securing justice for mesh-injured women is right up there at the top of the list. Let me simply say to those watching at home and those in the Public Gallery that the fight goes on.

Emma Little Pengelly: Let me begin by adding my voice to those of other Members in congratulating the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing and introducing a debate on this important issue.
I agree with much of what has been said by Members on both sides of the House. It is good to hear such similar views expressed about the need to think about what action should be taken to help women who are suffering some horrendous conditions as a result of this procedure. Unfortunately I did not have an opportunity to take part in the Westminster Hall debate, so I have found the many speeches that I have heard today very informative. Some, indeed, have been very technical. Questions have been asked, and I the answers will  be useful to us because we shall be able to convey them  to our constituents. I also welcome the specific recommendations that have been made, particularly by  the hon. Member for Kingston upon Hull West and Hessle. There seems to be a difference of opinion on whether mesh operations should be suspended while the audit and other matters are being resolved. I think that many of us are somewhat confused about why the risk should have been considered acceptable.
Like, I suspect, many other Members, I first heard of the issue when I was contacted by a number of constituents via social media. I subsequently met some of them face to face. The right hon. Member for New Forest East (Dr Lewis) described the specific circumstances of some of his constituents, and my experience has been very similar. I have sat and listened to many women describe what they have suffered. Theirs is a strong, powerful story of pain, and of the incredible impact on their lives, their families, their marriages and their relationships. Hearing such stories, we must ask ourselves how such pain, risk and suffering can be justified by the cases in which the procedure does work. I know that many of us are appalled when we hear of the experiences of the numerous women whose lives have been blighted by these procedures.
A number of issues have been raised, and I do not want to reiterate what has already been said. Instead, I shall focus on two elements that I do not think have been dealt with in any detail. First, we need to ensure that all the women affected are identified and fully supported, and benefit from the highest-quality care and intervention that can be provided at this stage. That, for me, is a priority, which involves two important considerations. One is the question of where we are right now—what these women are suffering right now, and what we can do to help them to try to find resolution. That journey will require the highest levels of expertise and support.
As we have heard, many of the medical interventions involved are complicated, and, given their previous experience of medical procedures, many women are understandably deeply apprehensive and worried about undergoing further necessary procedures. The right experience and qualifications, and a wrap-around support service, are critical not only to securing the best medical outcomes but to building confidence among the many women who have been let down by interventions in the past. I emphasise with women who know that they will have to undergo even more medical procedures, even after having such horrific experiences and suffering the consequences of the previous interventions.
There is also the question of the suspension of mesh operations. I have written to the authorities in Northern Ireland and to the Secretary of State requesting a suspension pending the outcome of the audit and the review. In circumstances such as this, I am always very aware that many of us here are not doctors. We are not members of the medical profession. We are told—this has featured in the responses to my correspondence—that even Departments and their civil servants must and do listen to the medical professionals. It is important for NICE to move more quickly, though, because its recommendations will be crucial for frontline care, advice and the pathways that are followed for women who present with the issues that have led to this procedure.
Secondly—this has been discussed at some length today—there are the critical questions of why this happened  and why it was not picked up earlier. I welcomed the Secretary of State’s announcement of a review, because it will cover some of those issues, but we need to understand how we have reached this position. I have spoken to constituents, and to members of the lobby from across Northern Ireland, and their common experience is that they were not taken seriously enough at all stages. Complaints made to medical professionals about complications were often dismissed, even when the women were in extreme and chronic pain. The database has been referred to. There should have been a database at an earlier stage so that the information could be located. I fully support a UK-wide database, because, as has been said, it would be the best way of gaining a wider sense of what is happening.
It is worrying that hundreds and thousands of women across the United Kingdom were individually presenting with complications from these procedures, yet nobody joined up the dots until a very late stage. I am glad that that is now happening—I am glad there is a review—but many women have had to suffer for too many years without the dots being joined and action being taken.
It is not acceptable that women presenting with problems were told by some GPs or other medical practitioners that perhaps it was just women’s problems—that these were the types of complications that generally arise in issues associated with the menopause. The problems were dismissed, and women felt dismissed and that their issues were not being taken seriously. That is wrong and unacceptable.
We hear a lot at the moment in Northern Ireland—I am sure it is the same across the United Kingdom—about patient-focused care and the patient-focused experience in the health service. Yet in all the stories I have heard about this issue, there is the common experience of people not being taken seriously and not having a patient-focused experience. That must be addressed urgently.
I look forward to the outcome of the review, and to some of the actions being discussed such as the audit and the setting up of the database, but it is important that we identify not only what went wrong, but clear actions to take to stop it happening again. We must learn from the mistakes of the past and make sure that actions are identified and that we progress.
Finally, I thank the advocates who have done a huge amount of work to raise awareness of this issue across the United Kingdom, including in Northern Ireland.

Kevin Hollinrake: I thank and congratulate the hon. Members for Kingston upon Hull West and Hessle (Emma Hardy) and for Pontypridd (Owen Smith), as is customary and also entirely justified on this occasion. This issue must be kept in the public eye.
One of the great privileges of being an MP is being able to give people a voice—to represent people in our constituencies who have been wronged, often in terrible circumstances through no fault of their own. In this case, for me that person is here today in the Gallery: Jacqui Cheetham. I am delighted to be able to represent her story, and her words are far more powerful than mine could ever be. When she visited me at my surgery what came across was the scale of the problem and also  its traumatic consequences given the relatively minor condition that Jacqui suffered from before the operation took place.
I would like to use Jacqui’s words rather than my own, because, as I have said, they are far more powerful than mine could ever be. She explained that she had two surgeries using mesh, in 2005 and 2006:
“Within a few days of surgery I had severe pain in my groin and bladder. I was referred back to York Hospital on many occasions. The surgeon said he could find nothing wrong with me and eventually recommended I saw a psychiatrist, as he believed it was all in my head. As a teenager I had a history of mental health problems when my parents went through a nasty divorce. I was left to bring up my younger sister and take my main, secondary school exams. I simply could not cope but because this is on my medical records, even though the mesh operation was many years later they still referred back to that time and thought this must also be psychological. My GP spoke up for me and told them I was not depressed and demanded they find a solution. Eventually I was given a MRI scan and the mesh was found sticking into my bladder. I was then operated on to partially remove the mesh. After the operation, the surgeon described the pain of the mesh sticking into me as being like barbed wire as the raw edges of the material had hardened. It’s intended that your body should mould itself into it and removal would be like extracting it from concrete…
Since 2006 I have lived my life in constant pain. I take concentrated Oramorph and wear…Buprenorphine patches. I also take codeine for ‘break-through’ pain.
I was a fit young mother in my late 30s when I had this done, suffering mild incontinence. My ambition was to run the London Marathon and I found the incontinence merely a nuisance. How I wish I could go back to those days! I would never have had this operation, had I known this possible outcome. I was not warned of any such dangers.
I now cannot walk far. I can’t stand or sit for extended periods of time. I struggle with simple tasks that require my concentration. Both my drugs and my pain affect my sleep. I am now 50, though I feel much older.
Quite simply, this operation has ruined my life and has had a massive impact on my family. My children are now grown-up but they were young at that time and I was unable to be a proper mum to them; unable to run and play with them as a parent should. There seems to be a misconception that the mesh which causes the greatest problems is “prolapse mesh” but this simply is not the case. All mesh can cause problems.”
I know that the ministerial team is very concerned about, and aware of, these issues, in part due to the fine work of parliamentarians. Ministers rightly point out that no healthcare system in the world has yet banned this treatment, and they set about the review in February 2018, which has provided much of the information that we now have to address these points.
As my right hon. Friend the Member for New Forest East (Dr Lewis) pointed out, the scale of the problem is becoming clearer, but I do not believe we understand the true scale yet. The recent Guardian report said that out of 100,000 operations there were 6,000 removals, so there is an issue with at least 6%, and that is just the ones that have been removed, so we know the scale is greater than is currently acknowledged.
Something needs to be done now. It is heart-warming that the people who come to our surgeries to tell their stories want most of all to prevent this from happening to others, and we must pay credit to the people from the Sling the Mesh campaign for what they have done to benefit others as well as trying to redress some of the difficulties they experience themselves.
The hon. Member for Kingston upon Hull West and Hessle raised the issue of physiotherapy, and she is absolutely right: prevention is better than cure. She mentioned that this problem has cost the healthcare system £245 million; it would be a true economy, not a false economy, to implement what she suggests as a simple first step for new mothers.
We also need to get to the bottom of the issue by having a true audit, including of, for example, private patients, to make sure we know the true scale of the problem; I support those calls. It must also be sensible when there are alternatives to look at a suspension of this treatment today. Burch colposuspension and autologous sling are alternative treatments, and it makes sense to me and certainly my constituent to suspend this treatment and look at other treatments in the meantime while we find an alternative. Perhaps the new Sheffield University treatment will prove effective, but, as the Chair of the Health and Social Care Committee said, it needs to go through a clinical trial rather than women effectively being used as human guinea pigs. I support the extension of that until clinical trials can show that we have a solution without the traumatic consequences that affected so many women.

Carol Monaghan: I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this debate and on the power of work that she has done on behalf of the women affected by mesh. I also pay tribute to the chair of the all-party parliamentary group on surgical mesh implants, the hon. Member for Pontypridd (Owen Smith), for his work. I declare an interest as a member and vice-chair of the group. In the run-up to this debate, I have been contacted by many constituents whose lives have been devastated by mesh. Because of the sensitivity of the topic and the embarrassment that many women feel, it is a major step for them to come forward and speak so bravely about their experiences. For these women, what started as a slight leakage of urine and an embarrassing discomfort has escalated into life-changing disabilities, and I want to use this speech as an opportunity to raise some of their cases.
My constituent, Karen, underwent a hysterectomy in 2008. The following year, she suffered a significant prolapse and was given a pelvic organ mesh. After that procedure, she began to suffer from severe incontinence, which affected her ability to work. She mentioned this to the consultant, who said that there was a simple procedure that would help. She had that procedure, but was given no further information about the risks and possible complications. In 2011, she started to experience severe pain and was referred to a new consultant, who told her that the pain had nothing to do with her implant. She finally had the implant removed in 2013, but has been left severely disabled and now has to use a wheelchair when she travels long distances. This has been a real problem for her because, she says, people talk to the person who is with her, rather than to her. She therefore feels as though she has been dehumanised as a result of this as well. Had Karen been told what the mesh procedures entailed, she would never have agreed to have the implant. She and a group of survivors in Scotland have set up a Facebook group. It started with 17 women, but it now has more than 500 members.
Another constituent, Jean, had her implant inserted in 2006, but she realised from day one that it had not worked and that she was still incontinent. She says:
“The full side effects of having polypropylene plastic TVT-O are as yet unknown. What is known is removal is complicated and carries its own risks, due to the fact that the mesh implanted in the woman’s pelvic region is designed to be permanent. In cases where a surgeon does a partial removal and leaves the rest then the long term result can be further degradation and an acceleration of mesh debris into the body. To remove the Monarc sling that I have, a surgeon has to cut through many structures including bone and muscle, and is known to be nearly impossible to remove safely without further damage.”
In fact, one consultant has described mesh removal as being like trying to remove warm chewing gum from someone’s hair.
At the most drastic end of the scale, some women now face losing their organs as a result of this procedure. This has happened to Claire, a mum of three, who says:
“I had a mesh implant in September 2011 for stress incontinence. I woke with excruciating pain and struggled to walk. I had the mesh removed in July 2015 but unfortunately the damage I suffered is severe. I am now disabled for life. I use crutches for short distance, wheelchair for longer. My nerves are severely damaged, I have autoimmune issues, foreign body reactions, currently use anal irrigation system for my bowel as it can’t work on its own. Next for me is to have my bladder and bowel removed. Mesh products are simply not fit for use in the human body. These procedures need to be stopped now.”
Cathleen, from Benbecula, a constituent of my hon. Friend the Member for Na h-Eileanan an Iar (Angus Brendan MacNeil), has said:
“The Government is currently banning the use of plastic because of damage to the environment, destroying sea life and leaching into the food chain. Why on earth place such plastics into the human body when I like many others have suffered mesh erosion as my body rejected the polypropylene?”
The issue that is raised repeatedly in all these cases is the lack of information given to patients. Some were told that the procedure was simple; others were told that a little piece of tape or a sling would be inserted. None was told about side effects or complications. Most were not offered non-mesh procedures, which might cost slightly more in the short term but which would have massive savings in the long term because these women would not need to live on benefits, having had to give up work, with all the other problems that that entails.
In Scotland, the suspension of mesh has been welcomed, but because the regulation of such devices is still a reserved issue, we need the MHRA to stop recommending the use of mesh before it can be banned outright. Medical devices do not go through the same rigorous level of testing as drugs, and the effects are often not experienced immediately. This is why it is so important to carry out an audit of the women who have had  the procedure. I welcome the review of surgical  devices announced by the Government, as well as the announcement that they will conduct a full registry of all mesh procedures. However, it should be noted that the number of women affected may well be far higher than estimated. Many women who experience problems are told that their issues are not mesh-related. Are  those women’s problems being captured in the current mesh figures?

Gordon Marsden: I, too, have constituents who have been affected by this, and one of them has written to me to say:
“I had this operation carried out—it was only effective for a few months and had failed, leaving me with constant discomfort…The operation itself was a long one and I have so far managed to put up with this discomfort as I really don’t want further surgery.”
Does the hon. Lady—and indeed the Minister—have any thoughts on how many people might be going under the radar because they are in a similar situation to my constituent?

Carol Monaghan: I thank the hon. Gentleman for his intervention. That concern has been raised time and again in the all-party group. We believe that many of the women affected are not being captured in the figures, and it is important that we should carry out an audit to find out what is going on. That audit should include GP visits and visits to consultants. They should all be part of it.
Mesh implants have been described as the “gold standard” treatment for incontinence and as a “minor procedure” that would change lives. Sadly, the procedure did change many lives, and crucially, the device manufacturers who have marketed mesh so aggressively are making a profit on it. For the women affected, the manufacturers’ profits have come at a heavy price. My hon. Friend the Member for Argyll and Bute (Brendan O’Hara) has been working closely with a constituent, Nancy from Dunoon, who was left suicidal after having mesh implants several years ago. Four months ago, Nancy underwent an operation to have the mesh removed, and I am sure the whole House will join me in wishing her a full and speedy recovery. She has said that
“if they’d discovered this kind of serious fault in a car, they’d have recalled them all and stopped making them. So why didn’t they do that with mesh?”
It is important that we now have a complete suspension of mesh implants. Also, a number of Members have mentioned that physiotherapy should be offered as standard for new mothers, to give them other methods of dealing with slight incontinence and to help them to restore their core after birth. Many mesh survivors are now calling for a sunshine payment Act, as there is in America, that lists all industry funding, sponsorship or grants received by GPs and surgeons. This would show any conflicts of interest, and it would help with all medical issues, not just mesh. Finally, I would like to pay tribute to the campaigners from Sling the Mesh and from Scottish Mesh Survivors for all their work in bringing this issue to the attention of the wider public and to the attention of us here in this place.

Kevin Foster: It is a pleasure to be called to speak in this debate, and I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing it. It has been quite something to listen to the many stories that have been repeated here this afternoon. My involvement in this issue was prompted not only by conversations with my former colleague in the Ministry of Housing, Communities and Local Government, my hon. Friend the Member for Eastleigh (Mims Davies), but by the case of my constituent, Mrs Beverley Jelfs, who had mesh inserted for a prolapse.
When she emailed me, she said:
“My life has changed so much since having this device inserted in me in 2011. I can no longer work due to pain, fatigue, not able to sit or stand for long. The mesh eroded through my vaginal wall, which 7 weeks later had to have part removal. I have no intimate relationship with my husband, due to the mesh damaging me…I have gone from a very busy and socially active life, to being a depressed lady.”
That sums up the impact that the issue has on her. Although her work was done at a local private hospital, I also asked my local Torbay Hospital—the main NHS hospital serving my constituency—for details of the approach it adopted.
Given the age demographics of Torbay, I had expected slightly more cases to be raised with me. Those that have been raised involve people who have been treated at a particular private hospital. Given that this is a wider issue, I do not think that it is constructive to bring the name of the hospital into the debate, but it is interesting to note that that is where these queries come from.
I was pleased to get a detailed response from Julian Barrington, the consultant in obstetrics and gynaecology at the hospital, giving me some of the figures for the work he has done. I am pleased to note that the failure rates reported back on some of his cases have been a lot lower than some of the averages, but in his letter he makes the point that none of the patients in Torbay have been treated with Ethicon meshes, over which most of the concerns and complications have arisen. His other comment is welcome: given some of the issues being raised, since October 2017 he has suspended all vaginal surgery using synthetic mesh until the results of the NICE recommendations are published and until professional medical bodies make a decision.

Owen Smith: The hon. Gentleman is making an incredibly interesting point. Does he agree that it is inexplicable that NICE continues to say that it cannot produce its new guidance until the spring of 2019, when we and the medical fraternity have been asking for it for the past two years?

Kevin Foster: I think that the comments make it clear that medical practitioners are waiting to hear what the guidance is and would like it as soon as possible. As politicians in this Chamber, we should not necessarily look to say what the NICE guidance should be and should not put pressure on NICE to come up with particular outcomes, but NICE should look to resolve this uncertainty.
I welcome the pre-emptive approach that my local hospital has taken, but that then leads to a debate about whether other practitioners are continuing and whether my hospital is taking the right approach—I believe it is, and I suspect that Opposition Members who have been involved with this issue believe that it is, too. It is clear that guidance needs to be produced as quickly as it sensibly can be to allow hospital clinicians dealing with patients day to day to know that they are making the right decisions. I welcome the fact that my hospital has made a pre-emptive decision, but agree with the hon. Member for Pontypridd (Owen Smith) that it makes sense for NICE to try to resolve the issue as quickly as possible and provide clarity.
It would be interesting to hear from the Minister whether it is becoming common practice in the NHS for individual hospitals and surgeons to adopt the approach taken by Torbay and South Devon NHS Foundation Trust. Is it more common or does it involve only a small number of hospitals? Is there an emerging body of medical opinion on this matter? Although I might welcome what Torbay Hospital has done, if individual hospitals effectively start forming their own policy that will raise questions in other locations.
Given the concerns raised with me, I welcomed the review announced in February 2018. I can remember being in the Chamber to listen to the Secretary of State’s statement on this and a range of issues affecting women’s health, as well as on whether some of the processes we have in place are as strong as they are in other areas. To reflect on the point made by the hon. Member for Glasgow North West (Carol Monaghan), given the issue, many of those affected are reticent about making a noise. I sought direct permission from my constituent to mention her name and condition in the Chamber, but one wonders whether there are a number of people who do not want to make a noise about this—through embarrassment, to put it bluntly—which makes it different from concerns about other treatments.
I would also be interested to hear from the Minister what liaison is taking place between the UK Government and the Governments of New Zealand and Australia, who have adopted an approach that is similar to my hospital’s. What impact is that having? I have not had complaints from people about not being able to have a procedure for a particular problem while this treatment is suspended, and that tells me that the hospital’s decision has not had a negative effect. I would be interested to know the experience of clinicians in other jurisdictions that are incredibly similar to us, particularly those from New Zealand.
Reading the motion, I can understand the call for a public inquiry. My only reticence is that such inquiries can become lawyer-fests. I would much rather we were dealing with the situation now, and getting guidance to clinicians in place quickly. We could decide at a later date, perhaps, whether such an examination of what happened would be appropriate. For me, the priority is to get action towards a resolution and for those women and men who have been affected to find medical solutions that can deal with their existing, ongoing pain.
I welcome the debate. It is good to have had contributions at such a level. I am pleased to note the approach my local trust has taken, and I would be interested to see whether that trend is emerging across the NHS and, if it is, what impact it is having on statistics for those who are negatively affected. Does it have any impact at all on waiting times for a particular treatment? If it does not, the pre-emptive approach would seem to be right clinically, in dealing with the problems we have heard about today and in preventing more people from being affected.
I hope that today’s debate will also give hope to those who are suffering that their plight has not been ignored—it is not something that has been talked about quietly somewhere else because of any perceived embarrassment. I hope that lessons will be implemented that prevent others from having to go down the same path as my brave constituent, Mrs Jelfs. I know that her priority in  speaking out and having her story relayed was to prevent at least one other person going through what she has been through over the past seven years.

Bambos Charalambous: I congratulate my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this important and timely debate. Excellent points have been made by all Members who have spoken, so I will be brief to allow time for the Front-Bench responses. We have heard about some harrowing cases involving people’s constituents, most recently from the hon. Members for Torbay (Kevin Foster), for Glasgow North West (Carol Monaghan) and for Thirsk and Malton (Kevin Hollinrake). There has been cross-party support for the motion and the demands on the Government to act. I think that everybody who has spoken today thinks that mesh should no longer be used in surgical procedures until the inquiry reports back.
On 6 February, I had the pleasure of meeting some of the remarkable women from the Sling the Mesh campaign, many of whom are in the Public Gallery looking down at us. These women have been left debilitated and in agony following mesh implants. I was shocked as each one told me about their own personal and horrific ordeal. They told me how they were in unbearable pain when they sat down or stood up, how they had gone from being active, energetic women in the prime of their lives to being left housebound, in some cases unable to work, with a complete loss of their sex life. I can only imagine the mental suffering that these brave women and other victims have had to go through.
One thing that I found particularly striking was how many of these women said that they almost did not have the mesh implants but were swayed by the casualness with which they were sold to them when they were weighing up their options on how best to resolve their medical conditions relating to prolapse or incontinence. None was told of the risks of vaginal mesh, and I am sure that if they had been they would have considered other, less risky, alternatives. No one goes to hospital expecting to be cured of one problem only to be given another a thousand times worse. There are serious questions that need to be answered about the mis-selling and promotion of mesh, and we have not had much of a response on that despite many requests.
I find it staggering that, despite the potential risks being known, mesh is still being used today. Surely its use should be stopped and women warned of the dangers. Even by the NHS’s own figures, 1% to 3% of vaginal mesh implants result in complications. The figure is far too high. Other studies have the figure as high as 10%, and it could be higher—we do not know. It is worrying that we have such cases at all. Whether the figure is 1%, 3% or 10%, even a one in 100 chance of being maimed by an implant is a price not worth paying.
The Government should follow the example of New Zealand, which has managed to stop using mesh. Is it really acceptable for the Government knowingly to allow women to be injured by the state in this way? How many more women need to suffer while they wait for NICE to complete its review?
The Government’s retrospective review of surgery for vaginal prolapse and stress urinary incontinence using tape or mesh is a welcome start to finding out how many women have been affected, but the scope of the review is too narrow and there is a real fear that women will be missed. Why cannot women from Wales, Scotland and Northern Ireland be included in the review, and what about men affected by surgical mesh?
I call on the Government to ban mesh implants immediately and to widen the scope of their retrospective review. NICE should bring forward its review and introduce pelvic floor physiotherapy on the NHS as standard for all new mothers. We need to find out what has gone wrong, and why. The victims of the mesh scandal have suffered enough. We need action now.

Philippa Whitford: I, too, pay tribute to the APPG and to the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy). I also pay tribute to the women who have campaigned. If they had not campaigned, the issue would not be at this point today.
As a surgeon for more than 30 years, I have to start by pointing out that there is no such thing as risk-free surgery. There will never be an operation about which it could be said there is not a 1% complication rate. When I looked at complications and talked about risks, I used to write them down on the consent form so that I went through every single one with patients. We talk about the complications that are minor and common, and we warn patients, “This will probably happen, but it’s minor.” The complications that are life threatening or quality of life threatening, even if they are rare, should be up there in block capitals so that women know.
We, as surgeons, have a duty to minimise risk and to inform the patient so that, as has been discussed, decent and informed consent can be given. The problem of this saga is that a lot of the surgeons were not informed. If a surgeon is doing 30, 20 or 15 mesh implants a year and they become aware of a problem only in two or three years’ time, it does not register in their brain as being common. We also know that many of these cases really presented only years later, so that feedback loop—“Oh my God, we have a problem!”—was not there. That is why so much of this is to do with regulation, reporting and, inevitably, the yellow card.

Gordon Marsden: Obviously, the hon. Lady has enormous personal experience of surgery and of this area. Does she agree that one of the other possible problems for some surgeons, although I hope not many, is that in this country we have historically been very bad at explaining risk-benefit analysis? If people are being offered an operation for a condition that is not necessarily life threatening, the judgment in a risk-benefit analysis is very different from that for something far more serious.

Philippa Whitford: In fact, there are studies showing how difficult it is even to explain risk, let alone risk-benefit, to patients. Certainly in the cancer field, in which I spent so much time, patients will go through really appalling treatments even if there is only a relatively small chance of cure. As a clinician, it is difficult to explain a lot of this.
Sufficient information has not been given to the medics, and therefore clearly not to the patients. We have heard this described as a “minor, straightforward procedure”.

Owen Smith: Does the hon. Lady agree that part  of the problem is that mesh was marketed so widely  as being a quick fix? Previously, far more expert urogynaecological surgeons would have undertaken  what was far more difficult and invasive surgery—colposuspension or autologous sling. When it went to day-case surgery and, effectively, keyhole surgery, a much wider range of less expert surgeons was suddenly involved.

Philippa Whitford: I would echo that. We should always be a little suspicious whenever an impression is given that an operation is easy and quick. We hear talk within the medical system of the problems of specialisation and how, actually, we need to go back to having more generalists. The depth of knowledge on breast cancer now would make it impossible for a general surgeon, who might also be doing upper gastrointestinal and lower gastrointestinal surgery, to keep up with that knowledge. That is why we will always need specialists. The danger is when something is thought to be trivial and straightforward.
Although it has been mentioned that the two problems—pelvic organ prolapse and stress incontinence, and particularly the latter—are very minor, there is a broad range. There will be patients for whom the condition is incredibly distressing and who simply cannot leave the house because of their incontinence. We should not put everyone in the same basket.
As has been mentioned, the traditional repair for prolapse would have been colposuspension, which lifts the womb and then buttresses the muscular tissues of the pelvis. The surgeons thought that by adding mesh to muscle that is clearly weakened—that is why prolapse happens in the first place—they would make the muscle stronger.
There was a perception that the results of colposuspension were poor, and a big American paper in 1997 suggested that prolapse recurred in 29% of women. As a surgeon, that seems like catastrophic failure, but, reading the small print of that paper, two thirds of those women were hugely obese and one third had bronchitis and were coughing all the time. There was also a high rate of smoking. It was not the average range of women with prolapse; it was actually a particularly high-risk group. Unfortunately, the paper seems to have dominated the profession’s perception for years.
The problem right across this is that not enough trial work and research were done at the beginning and that the follow-up was far too short. What we have seen is that the mesh problems emerge only after time goes on. There was a Cochrane review in 2007 looking at multiple smaller studies, and it showed no benefit from the use of mesh in prolapse. Since then, we have seen a slow decrease in the use of mesh, but the recent review shows that 2,500 women with prolapse in England had mesh put in last year. That means the issue is still happening.
A 2011 EU study showed no benefit from mesh in prolapse even for recurrence, and one of the few prospective studies, in which the data is collected as time goes on, also shows no benefit. That prospective study was published  in 2016, so the information has not been available for decades, and it found that the mesh complication rate at two years is 12%. That is at two years, so the rate can only go up. The Scottish review of 20 years of data from 1997 to 2016 shows only a 4% recurrence of prolapse after the traditional repair. Mesh is no better at avoiding recurrence.
Colposuspension has surgical complications: a surgeon might damage something; a surgeon might injure the bowel or bladder, which is much more common; or a patient might get a wound infection. Those complications fade as time goes by whereas, as has been reported in the Chamber today, the mesh complications do not occur early, but occur as time goes on. In Scotland, after the review, the advice is absolutely clear: mesh should not be used in cases of prolapse as a routine first procedure.
We have heard about stress incontinence and the option of physiotherapy has been talked about. That option should have been used much earlier; there should have been trials of it. As has been said, this is about getting to women in the post-childbirth period so that we have the chance of strengthening their pelvic muscles. The initial repair for stress incontinence was the tension-free vaginal tape, which developed in the late 1990s. A randomised controlled trial was carried out in 2002, with the one-year follow-up report finding only a 1% complication rate and finding that the patients had less pain, and that they recovered more quickly and went home more quickly. This seemed like a great solution, which is part of why the surgeons were so convinced by it; it seemed quick and easy. They were talking about a keyhole approach and the way we deal with gallbladder and other procedures.
The problem that has gone on since has been talked about. We have had the morphing of one tape into another, and one material and so on changing, with little other research having been done and little follow-up. When that trial did follow up its patients, it found that at 10 years the mesh complication rate was 5%. Because the focus was on not injuring the bladder, we find in clinical terms that that has been the focus of the clinicians, because that is what they knew from colposuspension. The idea that two, three, four or five years later people would develop mesh complications was something the clinicians were not expecting and certainly not looking out for.
The incidence of bladder injury for the retropubic tension-free tape was about 10%, which is why the transobturator developed. Someone who has seen an X-ray or a pelvis skeleton will know that the front of the pelvis is made of two struts, so that we are not so heavy that we cannot actually stand up, and the obturator is that hole. The idea was to keep away from the bladder and therefore reduce bladder injuries, and indeed this did that.
Bladder injuries were reduced from 10% to 1%, so, again, everybody was patting themselves on the back. But what happens is the spikes—the trocars—used to put these things in are going through muscle and close to nerves, and are coming out in the groin; they are coming near the muscles that allow people to pull their thighs together. That is where a lot of the side effects and complications have come, and there was definitely a huge upswing and surge in these complications after the obturator tape became the common approach. We also  had such slow recognition of what was happening. Many of us women in here, particularly us women of a certain age, will recognise that old story of women simply being dismissed, patted on the head and patronised.
An odd quirk of regulation is that the Federal Drug Administration’s regulation 510(k) allows any similar devices to pass through in a very simple fashion and they are not re-examined. Class I is low risk, and initially these tapes were all classed as class I, which means no research had to be done. They are now class III, which means a randomised controlled trial is required, and we see that Johnson & Johnson, and others, are withdrawing; they are stopping making these things because they would have to go back to carry out trials. The problem is that the tape and the trocars might have looked similar, but when the move was made from tension-free retropubic to a transobturator tape, we were talking about a totally different operation, and there was simply no evidence to show that this was either similar or better.
If something has been passed by the FDA, it tends to get passed in Europe, and the Medicines and Healthcare Products Regulatory Agency tends also to accept it without doing anything else. The European CE mark is only a mark of the quality of production; it does not imply anything about research. As my hon. Friend the Member for Glasgow North (Patrick Grady) mentioned, there is a plan to develop the EU medical devices regulation system from 2020, but, unfortunately, the UK will not be part of that, unless there is a specific negotiation.
The problems began to be recognised in 2012, because of the campaigners, their persistence and their speaking out. In 2014, the then Cabinet Secretary for Health and Wellbeing, Alex Neil, advised all health boards in Scotland to suspend meshes until there was some degree of clarity. It might have been stimulated by that, but certainly at the same time the Australian Therapeutic Goods Administration started to look at its products, immediately de-licensing a third, reviewing a third and, initially, keeping a third as standard. But last November it de-registered all prolapse meshes, so these materials are simply not available in Australia.
The Scottish independent review was set up from 2014 to 2017, and its advice was unequivocal: there should be no routine use of mesh for prolapse, and as regards incontinence, if mesh was being used, registration was made mandatory. There has been discussion about where this registration will occur. Obviously, the colleges have been developing a registration, but we need to know about everyone who had a mesh in. This could be done through scanning the barcode off the mesh and registering it in the notes—that is the obvious way to do it. Having had to review all the case sheets of breast reconstructions after the PIP— Poly Implant Prothèse—silicone implants scandal, I know that it is really important that if something is being left permanently in a patient, we know how to recall it and who had that done.
As has been mentioned, we had the NHS England review and a paper was produced last year, using hospital episode statistics, that showed a 9.8% complication rate at five years. Again, we can expect that to climb. The review published on Tuesday showed that about a third of the 72,000 patients who were treated for prolapse  were treated by mesh; that is between 2008 and 2017, and we see a fall over time, so the rate might be higher during the earlier period between 2000 and 2008.
We have seen a 13% drop over that time in prolapse meshes, but, as I say, in prolapse there is utterly no benefit to them and therefore there can be only loss, so it is hard to justify why so many patients in England are still having prolapse meshes. Some 100,000 women have had mesh incontinence tapes, and this has decreased by 48%, meaning that the overall decrease in the use of mesh over that period is about 32% in England. Since the Scottish inquiry, the reduction in the use of mesh has been 94%—and that is continuing.
The hon. Member for Kingston upon Hull West and Hessle mentioned Dr Wael Agur, whom I am lucky enough to have as our local gynaecologist. I have been able to meet him and get information with him. The only places that are using incontinence meshes are the two specialist units in Glasgow and Edinburgh. In Scotland, a consent process has been developed, which is now being looked at by the colleges so that it can be rolled out, and, obviously, we are talking about usage in tiny numbers here.
Even though registration is mandatory, none of the other health boards is doing this, so it is not expected that Scotland will have many patients registered. What Dr Wael Agur and other colleagues are using is a small piece of rectus sheath, which is the tough tissue we have in front of our muscles. Those who are lucky enough to have a six pack—I do not see many in here— will find that that is very strong tissue. [Interruption.] We do not ask anyone to show them, please. Only about 6 cm of this is required. So we are using the patient’s own tissue and we will be back to an autologous repair, where there might be complications, wound infections and failures, but we would not see this progressive problem.
So what went wrong? Not enough research was carried out and, categorically, there was not enough follow-up. The survey that was reported on Tuesday now gives NHS England a denominator of how many patients have had mesh, but I am sorry to say that just using hospital episode statistics does not give a numerator as to how many women have problems, so I suggest a survey of all those patients or a review is necessary, in order to know how many, even within the NHS, have got these problems.
In addition, as we have heard, there was poor information on which people could base their consent; as I say, the clinicians did not know, because no detailed trials were being done of these new techniques and certainly there was no decent audit. Women were being dismissed and patronised. The regulatory system was far too complacent, simply taking things from the FDA all the way to the MHRA and not looking at changes in technique. The audit was very poor, with a recent survey showing that only 27% of patients who had had meshes were registered.
Finally, the yellow card system failed, yet again. The hon. Member for Congleton (Fiona Bruce) mentioned the other scandals associated with sodium valproate and Primodos. Unless patients are aware of the yellow card system and unless GPs and doctors have it literally in the front of their brains, people will not send a yellow card until they are sure that the drug or the mesh caused the problem. For any new drug, for any new technology that is being implanted, and for any baby born to a mother on medication, there should be a yellow card,  because the whole point of the yellow card system is that someone centrally is able to notice. That is why we need more of these yellow cards. There is clearly a problem, so we need better registration and reporting, so that we do not have to have another similar debate in future.

Sharon Hodgson: I thank my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this important debate and for her passionate speech. Like me, she has been shocked and horrified by the stories we have heard from men and women who have had their lives turned upside down because of surgical mesh. I also thank my hon. Friend the Member for Pontypridd (Owen Smith), who spoke with such passion and knowledge. He was campaigning with the all-party group on surgical mesh implants long before I even came across it, and I am grateful for his contribution and continued leadership.
I thank all Members who have spoken in this excellent debate: the hon. Members for Totnes (Dr Wollaston), for Congleton (Fiona Bruce) and for Glasgow North (Patrick Grady); the right hon. Member for New Forest East (Dr Lewis); my hon. Friend the Member for Peterborough (Fiona Onasanya); the hon. Members for East Renfrewshire (Paul Masterton), for Belfast South (Emma Little Pengelly), for Thirsk and Malton (Kevin Hollinrake), for Glasgow North West (Carol Monaghan) and for Torbay (Kevin Foster); and my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous). The hon. Member for Central Ayrshire (Dr Whitford) spoke for the Scottish National party with such knowledge, and it was a privilege to be in the Chamber to hear her speech. I thank them all for their thoughtful contributions, and I thank their constituents who have allowed their experiences to be shared with us today. It has been distressing to hear their stories and I sympathise with anyone affected by surgical mesh.
Finally, I thank Kath Sansom, who leads the Sling the Mesh campaign, and who I know is watching from the Gallery, for all her hard work in uniting the women affected by vaginal mesh implants and raising awareness of the tragic impact that they have had on so many lives. I thank everyone who is part of that campaign for everything that they do to raise awareness and support women.
After the Westminster Hall debate in October last year, and the media coverage that followed, more women came forward as victims when they realised that the mesh was causing their additional health problems. I am very sorry to say that my 73-year-old mam was one of them. She likes to watch my debates and speeches, as do all our mams, I am sure. When she was at mine one Saturday, while I made lunch, I sat her down to watch some of the speeches that I had made that week. There she was with my iPad: I put on the Westminster Hall debate, it started to play, and I said, “I’m so pleased you haven’t had anything like this done.”
You see, Madam Deputy Speaker, over the past four to five years my mam has been back and forward to the doctors with loads of health issues, from IBS to constant urinary infections, and from stabbing pains in her groin to pain walking and trouble sleeping because of pain and twitching in her legs—and more. It has been never-ending.  She said, “I’ve turned 70 and I’m falling to pieces.” She has had cameras everywhere, which is not always pleasant and can be very uncomfortable, but all to no avail. No diagnosis or solution has ever been found. With that background knowledge, the House can imagine my horror when she said, “Oh, no, I just had some tape put in to stop the leaking when I coughed and sneezed!” I had no idea that she had had that done.
As the hon. Member for Torbay said, sometimes women—even your mam—do not like to talk about these things. When I asked her why she had never mentioned it, she said, “Oh, it was quick—I was in and out on the same day. And you’re always so busy, so I just didn’t mention it.” It had not even occurred to her that there could be a connection between what she had been going through for the past four or five years and this procedure that she had had done five years earlier.
As the House can imagine, I went into panic mode, because although we are talking about mesh today, surgeons use many different names for it—tape, ribbon and sling are the more patient-friendly ones. I am also told that they now like to use the phrase “Don’t worry—it’s not the mesh that they talk about in the media.” Surgeons must be absolutely clear with their patients what treatment they are about to receive and address any concerns that they might have, instead of talking about the success of the majority or dismissing those concerns outright.
After the sudden realisation, all my mam’s symptoms over the years suddenly began to make sense and could be attributed directly to the mesh. I am pleased to say that, thanks to the help of the fabulous Kath Sansom, my mam is now armed with all the facts and arguments to take to her GP and surgeon. She has done that and is on the long road to getting reversal surgery, if that is the best option for her. She has also had to come to terms with the fact that she may never be the same again, with the associated guilt that she agreed to the procedure. She trusted the medical profession to do her no harm.
My mam is lucky at the moment, compared with some of the other cases we have heard about today, which she recognises. A Sling the Mesh survey found that more than 78% of patients have pain when walking and sitting; 69% of women have pain that prevented intercourse; more than 60% of patients suffer with anxiety and depression because of the mesh and the symptoms that it causes; and almost 54% suffer with nerve damage. I have seen the piles of medication and medical equipment that some women have to use on a daily basis to try to live a life with a bit of dignity. Before the mesh, these were fit, healthy and, in some cases, young women, as we have heard. Now they need assistance to do simple things such as tie their shoe laces, pick up their children, or even use the toilet. Some have lost their sex lives, their marriage or their job. This is a tragedy for these women and their families. The effects of mesh have been so unbearable that, I am sad to say, some women have tried to end their own lives. Innovative and effective treatments should not do this to patients, and the Government must not stand idly by while women suffer in pain like this. The Opposition continually urge NHS England and NICE to act immediately to update the guidance before 2019—as we have all said—and to suspend the use of vaginal mesh.
The Government’s “Retrospective Review for Vaginal Prolapse and Stress Urinary Incontinence using Tape or Mesh”, published just two days ago, is a first step in  understanding the sheer scale of the number of women affected by this scandal. Unfortunately, the effects of mesh are hidden within the document—it takes a bit of a numbers expert to be able to work their way through it. So hidden and complex is the review that, on Tuesday, the Minister in the other place announced that he was giving his expert a month to work it out. I will be waiting with bated breath for that analysis.
It is clear that the review fails to show up all the women who have been treated with mesh in the UK. It shows only the number of women treated in England on the NHS, meaning that patients treated in Wales, Scotland and Northern Ireland, and patients treated privately in England, were not included. The audit does not include the sheer number of women who have gone back and forward to their GP for pain relief or antibiotics but who have not yet been referred to a consultant, or even those women who have not yet even made the connection and considered that mesh could be the problem, as was the case with my mam. Why were those women missed out? What is the Minister doing to ensure that their concerns are heard and that they are counted in the numbers?
When the audit was announced, I called for a suspension of the use of mesh while it was carried out. As the hon. Members for Totnes and for Glasgow North West and others have mentioned in their contributions, medical devices do not undergo any clinical trials or rigorous evaluation in this country. If ever there were a case to prove that that needs to change, it is surgical mesh.
As I have said, and as the hon. Member for Glasgow North West mentioned, if this were a car, an aircraft or even a washing machine or a dryer that was malfunctioning and causing life-changing harm in 10% to 15% of cases, its use would be stopped and the product recalled immediately while the problem was investigated. It would not even need to be as high as that, or even the 1% to 3% that was referred to—just a handful of incidents triggers a recall.
The suspension did not happen, so will the Minister please tell the House in her response how many women have had a mesh implant while the audit took place? Does she know how many women since March 2017 have been treated with a mesh implant or had mesh removed, as the audit went up to only March 2017—a year ago? These newly mesh-implanted women may not have any symptoms now, or if they do they will not necessarily realise that the mesh is to blame, but they may do so in a few years’ time.
Since the Westminster Hall debate last year, the audit and the wider medicines and medical devices safety review, patients who have been treated with surgical mesh—not specifically vaginal mesh—have come to feel that their experiences and concerns are not being considered by the Government. Obviously, I include men in that category. The majority of hernia mesh operations are successful. However, complications can leave patients in chronic pain, which patients were not warned about.
According to NHS data, 10% of people who have had hernia mesh fitted go back to their clinician at some point after their surgery. The former surgeon Peter Jones says that the risks of using hernia mesh are so bad that he himself would not take the risk. Will the Minister respond to the concerns of patients who have been  harmed by surgical mesh and elaborate specifically on what the Government are doing to review the harm caused by all surgical mesh—not just vaginal mesh?
Let me repeat my calls to the Government once again: the use of surgical mesh must be suspended and NICE must bring forward its review. A simple, quick and cheap operation has turned far too many patients’ lives upside down. We must stop playing Russian roulette with these patients’ lives. It really is time to sling the mesh.

Jackie Doyle-Price: I add my thanks and congratulations to the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this debate. She approached this issue with her characteristic passion and forthrightness and gave me a number of challenges—again. I am pleased that she acknowledged that, since we last debated this, there has been progress. It is in that spirit that we need to continue this dialogue not just to address the issues, but to make sure that we do the right thing by those women who have been harmed by the use of vaginal mesh.
Ultimately, the tragedy of this case is that women have put their trust in the medical establishment to look after them and to make them well, and they have come out with the most debilitating, life-changing injuries. In many cases, these were very young women. It is very clear from the clinical guidance on these products that they should not be used as a first intervention, and should be used only in very extreme cases. We are to be very concerned about the extent to which this has been adopted.
It is great that the evidence shows that the use of this product is less than it was. Clearly, as the hon. Member for Pontypridd (Owen Smith) pointed out, there was a spike in the use of the product, and that use was not always appropriate. That highlights the need for proper understanding of the risk of any medicine or product, and underlines the need for very mature and sensible conversations between medical professionals and their patients so that people understand the risks of treatments, as opposed to understanding just the benefits. Most of all, it illustrates the need for informed consent on the part of the patient. I have been horrified in this debate to hear how many women did not understand the treatment that they were getting. That is clearly unacceptable.
In that spirit, I want to continue this dialogue. As the hon. Member for Central Ayrshire (Dr Whitford) pointed out, women are often sent away and told that, “It’s women’s problems.” Women are often patted on the head by members of the medical establishment. None of us women in this place is a shrinking violet, but we have also fallen victim to that behaviour, which is just not acceptable. We need to do more to change the culture of our health service and the way in which medical professionals interact with women. If we do not, the outcome is exactly the experience to which those ladies who are sitting in the Public Gallery can attest. I am very grateful to them for sharing their experiences. Sharing our very intimate and distressing personal details is not the most comfortable thing in the world, but the work they have all done in sharing their  experiences has raised awareness and put the issue on the agenda. It has also made us more vigilant about protecting our own health when we are faced with problems. I thank them all.
Although there may be some specific points on which we differ, it is clear that we all share a determination to address the issues that have been raised. Clearly, a number of women have experienced extreme suffering, and it is important that the NHS does its best to make life better for those women and gives them the treatment that they need. I say to Members that if there is any evidence that women are not getting the treatment that they should be getting following a complex mesh procedure, please raise that with me and bring it to my attention and I will take action accordingly.

Gordon Marsden: I am very grateful to the Minister for giving way. She is acknowledging the depth of disquiet, suffering and pain, but she will also be aware from my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy), and indeed from my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), who spoke from the Front Bench, that there have been persistent calls for NICE to speed up the process. I ask the Minister a very specific question: what conversations has she had with her officials and NICE as to why they cannot bring this forward? Is it a question of a lack of appropriate aggregate evidence; is it a question of their own internal priorities; or is it a question of resources?

Jackie Doyle-Price: It is actually an issue of rigorous process. We need to make sure that NICE guidance has clinical integrity. The guidance to which the hon. Gentleman refers comes at the end of a longer process of other guidance that is going through the system. None the less, that intelligence is shared throughout—it is an entirely consultative process. The issues that we need to settle are all part of the public debate. Essentially, the publication of the NICE guidance comes at the end of that. The important thing is that everyone knows the issues and that we are very clear about the context in which this is an appropriate treatment. The guidance is very clear: this treatment should not be offered as a routine first intervention.

Owen Smith: I am not sure that that answer is correct, in as much as we know that there is no new clinical evidence to be produced in this area; there are no outstanding trials. Therefore, there is no reasonable reason why NICE cannot bring forward that guidance, and it certainly does not make sense for it to wait another year.
Finally, was the Minister surprised when the chief medical officer, who was sitting next to the Secretary of State, said on Facebook Live that she thought that the rate of complication in respect of mesh was between 15% and 20%—a stark difference from all previous estimates by Ministers or officials?

Jackie Doyle-Price: Let me emphasise that it is the robustness of the process that is at issue here. The guidance will be published for consultation later this year, and completed next year. There is a robust process for doing so.
The hon. Gentleman is right that the CMO suggested that there was a 15% to 20% complication rate, but I understand that she has written to him explaining that she misquoted the statistics and that the situation is more complex. That is one reason why the retrospective audit is so important. We now have a body of evidence that we can properly analyse, and as has been mentioned, my noble Friend Lord O’Shaughnessy has tasked the CMO with properly analysing the audit published this week so that we might more quickly draw conclusions.

Owen Smith: That is very interesting. I do not believe I have received a letter from the chief medical officer explaining that she got the statistics wrong. May I press the Minister to make sure that when the CMO looks at the register she offers a proper narrative analysis of what the numbers mean? We still have contested analyses of whether they show a bigger problem than we thought or whether it is the same. I think it shows a much bigger problem, but we need to understand the numbers.

Jackie Doyle-Price: I can absolutely give the hon. Gentleman that assurance. It is crucial that we address the matter transparently—that is very much the spirit in which I want to take this forward.

Julian Lewis: Before those interventions, the Minister said that if people are still not getting adequate treatment, it should be brought to her attention. As I mentioned, I have been contacted by constituents saying they felt trapped because the people who did the procedures were refusing to refer them elsewhere for a second opinion and for possible help from the very small number of people who specialise in the rectification and reversal of these procedures. What advice can she give my constituents about how to break out of this restriction on being referred to people in whom they can have more confidence?

Jackie Doyle-Price: I listened carefully to my right hon. Friend’s representations on behalf of his constituents, and they filled me with alarm, because we have given a clear indication on this point and have established 18 specialist centres to deal with the consequences of mesh. There is, therefore, no excuse for patients who require further intervention not being properly referred. Perhaps he and I could take this up offline to make sure his constituents get the support they deserve.
I want to put this in the context of our broader emphasis on patient safety. We have learned, through difficult experience, that there is never one measure or magic bullet to suddenly transform services for patients; it is about sensible dialogue between patients, clinicians and sometimes politicians—sometimes we can have a role in catalysing the debate. We all need to pull together to tackle all aspects of the issue. In some respects it is about the actual product—the vaginal mesh—but it is also about clinical practice and behaviour, as we have talked about. The most important thing, however, is the need to listen to patients, who, in this context, are of course women. We have to make sure that we listen to women when concerns are raised so that we can properly tackle those concerns as they arise. As I have said before, I am concerned about informed consent for patients, but the issues go much further, and generally we could do much to improve the performance of the NHS by placing a greater emphasis on that.
We need to consider the whole issue of clinical advice. We know that this product should not be routinely offered as a first intervention, yet clearly it is. I am horrified to hear of women in their 20s and 30s being treated with this product, when clearly it is not intended for them. It is obviously easy for me to make a superficial judgment on that without knowing about the particular cases, but on the face of it, it seems quite wrong.
The issue has been raised of what is an acceptable level of risk. I do not like to think about that in terms of percentages, because the acceptable level of risk will differ from patient to patient. If we are talking about some new mums, the level of risk clearly would not be outweighed by the benefits, but if we are looking at women suffering from horrendous conditions of incontinence, that is a very different debate. Again, we need to think about the broader issues. It all comes down to making sure that the guidance is properly applied and that clinicians who are recommending the use of mesh are properly making that assessment in discussion with their patients.
There has been a demand for a public inquiry. We have introduced the Cumberlege review, which is designed to make sure that we properly assess the interests of patients going forward. I know that many patients have felt that their views have been ignored. Baroness Cumberlege is very keen to hear directly from individual patients about their experience, and will be going round the country to do exactly that.
I could say much more, but I must conclude so that we can move on to the next debate. I will write to hon. Members, who I thank for contributing to the debate, to address some of their other points. We are determined to do our best for women who have been badly treated in having this procedure.

Emma Hardy: I thank everyone who has contributed to this debate, and I welcome the continued dialogue between the all-party group and the Department of Health. It was interesting to hear for the first time that the Department recognises that it is not just the process but the product about which there are serious concerns. I also welcome what appears to be an admission that NICE is introducing draft guidelines this year—is that correct?

Jackie Doyle-Price: indicated assent.

Emma Hardy: That is excellent. That is one of the things we called for. One thing that has come out more and more is that there needs to be informed consent.   People need to know a lot more about the risks. All the risks need to be written down in front of someone in block capitals so that they know exactly what they are letting themselves in for.
I press again, as I did at the beginning of my speech, for all new mothers to be offered pelvic floor physiotherapy, as happens in France. As the Minister has just said, it is unacceptable that a new mother with a small, relatively minor inconvenience should be offered something that could result in permanent, life-changing disability. I urge the Minister to look into that as well.
I very much welcome the fact that we will have the draft NICE guidelines next year. As we have spent a lot of this debate talking about our mums and what they say to us, I will quote my mum. She always said, “Where there’s a will there’s a way”. If there is a way of bringing forward those NICE guidelines, let us make it happen, because if there is a determination across the House to make it happen, I am sure that the Department can find a way to do it and end this misery for so many women.
I end by thanking again all the fantastic women up there in the Gallery right now watching this debate. We are only talking about this now because of your bravery in coming forward and speaking out, and I thank each and every single one of you. We cannot undo the suffering you have experienced, but by speaking out and being so incredibly brave, you will stop women in the future going through what you have gone through. I and every Member who has spoken today thank you.

John Bercow: I thank the hon. Lady and everybody who has joined us today. I hope that they have felt uplifted by the debate.
We now come, colleagues, to the Back-Bench motion on cancer treatment. [Interruption.] Apparently, before we move on I should put the question on the debate on surgical mesh. I thank the specialist Clerk for his help and for rescuing me. We will now be entirely orderly.
Question put and agreed to.
Resolved,
That this House commends the recent announcement of a retrospective audit into surgical mesh for pelvic organ prolapse and stress urinary incontinence; notes that vaginal mesh has been banned in other jurisdictions such as New Zealand; further notes that NICE guidance recommends against the use of surgical mesh for pelvic organ prolapse and that no NICE recommendations have been made for stress urinary incontinence; notes that Sheffield University recently announced the development of a new mesh material; and calls on the Government to suspend prolapse and incontinence mesh operations while the audit is being carried out, to bring forward the NICE guidelines for mesh in stress related urinary incontinence from 2019 to 2018, and to commit to a full public inquiry into mesh if the audit suggests that this is the best course of action.

Cancer Treatment

John Bercow: Just before I ask the hon. Member for Croydon Central (Sarah Jones) to open the debate, it is my honour, privilege and joy to welcome Baroness Jowell—Tessa Jowell—together with David, Matthew, Jess and others to the Under-Gallery, in what will be an extremely powerful and, I hope, constructive debate. Can I say to you, Tessa—and I say it on behalf, I am sure, of all colleagues—that I hope you will feel fortified and inspired by the warm embrace of parliamentary love which you are about to experience? It is now my pleasure to call Sarah Jones to open the debate.

Sarah Jones: I beg to move,
That this House pays tribute to the work of Baroness Tessa Jowell in her campaign to help people with brain tumours to live better lives for longer; recognises the Government’s increased funding for research; and calls on the Government to increase the sharing of health data and promote greater use of adaptive clinical trials.
May I start by thanking you, Mr Speaker, after what has been a very busy week, for being here today in the Chair? I know you have two interests here today. One, obviously, is your friendship with Tessa, but there is also your interest in brain tumours, having set up the all-party parliamentary group on brain tumours. We are all extremely grateful that you are here.
I also thank the co-sponsors of the debate, the right hon. Member for Old Bexley and Sidcup (James Brokenshire) and the hon. Member for East Dunbartonshire (Jo Swinson)—unfortunately, she cannot be here today—and all the Members who helped us secure the debate. I also thank all those who have gone before us in the all-party parliamentary group—people who have spoken many times in this place with greater knowledge than I on brain tumours and cancers. I also thank the Secretary of State and the shadow Secretary of State, my hon. Friend the Member for Leicester South (Jonathan Ashworth), for being here today—it means a lot to us all.
This is a really important debate about cancer. My father died of cancer—of mesothelioma—last June, three days after I was elected to this place. No one here is not touched by cancer. However, I want to start by talking about Tessa and to tell Members a story about her.
To say that Tessa is determined in the face of adversity is a major understatement. In early 2001, she had a thought: that we should bid for the Olympic and Paralympic games. Now, if hon. Members remember, we had had the Millennium Dome, we had had Wembley stadium, we were 10th, I think, in the medals table in 2000, and we had been even worse the time before. We had quite a low opinion of ourselves in terms of our ability to construct and in terms of sport.
However, Tessa read everything there was to read, and she convinced herself that it was a good idea. She then set about convincing everybody else. She was faced by a Cabinet and a public who had no faith in this idea at all. She went round every single member of the Cabinet, one by one, and personally persuaded them that this was a good idea. She turned the entire Cabinet to her view.
She then threw herself into the bid, making sure that every single diaspora community and every sports group felt that this was exactly what we should be doing. She went to the Mongolians’ national day archery demonstration; she went to the Indian craft and shooting competition. She supported community groups all over the country. She would go and talk to a group of children about how they would directly benefit, and then she would dash across the country and deliver a wordy lecture to a load of economists about the evidence base for sporting-led regeneration.
In the midst of this mayhem, she would go on holiday, but not like the rest of us would go on holiday. She would take herself off to Mumbai, where she volunteered for a charity that taught sport and life skills to children who were homeless in the slums of Mumbai. She was offered a hotel room, but she slept in a tent. Two weeks later, she would come back, after spending every day in the boiling heat helping other people, and she would feel refreshed and do round 2 of the Olympics, and we all remember what an absolutely glorious time that was, how proud of our country we were and what an achievement it was.
Now, Tessa has a new course, which has been brought about by her personal experience of a brain tumour. She has thrown herself into the campaign for people to live longer lives with cancer with exactly the same relentless optimism and total bloody doggedness as she did with the Olympics. When faced with this woman who walks through walls, never gives up and always gets what she wants, we could almost feel sorry for cancer.
Last May, Tessa was diagnosed with a high-grade brain tumour, called GBM, or glioblastoma. This type of cancer, like many brain cancers, is very aggressive and very difficult to treat. Life expectancy for patients is very poor and has not improved in decades. Some 60% of people diagnosed will die within one year, and yet only 2% of the funding for research goes to study brain tumours.
In January, Tessa led a very moving debate in the House of Lords, which I am sure we all watched. She talked bravely and openly about the reality of life with a brain tumour, but she talked of hope; she talked of hope for cancer patients across the world—hope that the revolution we need is close at hand, and hope that we can live well together with cancer. I am sure that that debate had a big impact on us all—people across the country and colleagues across both sides of the House. Today’s motion recognises the tireless work that Tessa has done on this so far. It calls on the Government to improve the use of patient data to drive forward medical advances, and to promote greater use of adaptive clinical trials.
There are lots of reasons for the absence of breakthroughs in brain cancer treatment. Of course, it is partly down to resources but, as Tessa has said, it is not just about money. We need to radically transform the way in which we develop new treatments, two aspects of which I want to mention today: clinical trials and data sharing.
There is a long history of failure in traditional clinical trials for brain tumours and no vital drugs have been developed for 50 years. The proportion of brain cancer patients taking part in a clinical trial is less than half the average across all cancers. Some 97% of brain cancer  patients want to share their data to help to accelerate research, yet we still do not have a proper national brain tumour registry.
After her Lords debate, Tessa led an expert roundtable that brought together senior figures from the Government, NHS, industry and research. It was a powerful meeting that set out the key priorities and the innovations that we need. The event helped to secure some really important wins for brain tumour patients, including commitments from NHS England to include people who had been treated for brain cancer in the roll-out of the cancer quality of life metric. Public Health England agreed to work with brain tumour charities to explore greater access to data. The event also coincided with the announcement of £45 million of research funding into brain tumours, supported by both Cancer Research UK and the Department of Health. It is a testament to Tessa that she can invoke such love and respect from colleagues of all sides and still be at the forefront of this process. Only this week she was in the Department of Health at the first meeting of the steering group that is looking into this, chaired by Lord O’Shaughnessy. But there is still a long way to go.
The Government are currently considering a raft of recommendations around these issues. I have two specific asks. First, this situation can only change through a global community working together collaboratively. This international movement exists; there are people who want to do this. We just need the structures in place and the barriers removed.
Secondly, we need a clear and conscious shift to new, more innovative models of treatment and care. We need a culture of research within the NHS, with wider access to adaptive clinical trials. The Cambridge model at Addenbrooke’s Hospital has seen patient involvement in research grow to 80%. That should not be the exception; it should be the norm.

Jon Ashworth: My hon. Friend is making an eloquent and remarkable speech. As I cannot stay for the whole debate, I hope that I may—with the indulgence of the Chair—make a brief intervention to say that Tessa Jowell is an inspiration to us all. On behalf of the shadow Cabinet, I pay tribute to her today. I know that all Members of the House find her bravery extraordinary. She has achieved so much, and we will work constructively with the Government to implement many of the recommendations that my hon. Friend is outlining.

Sarah Jones: I thank my hon. Friend for those lovely words and for the commitment to all work together, as, of course, we must.
Before I draw my speech to a close, I want to mention one more person by name. Jack Lloyd is 10 and lives in New Addington, in my constituency of Croydon Central. Jack has a brain tumour that is inoperable. His tumour was initially treated successfully but, sadly, another developed. Jack and his parents are facing the worst horror imaginable. He was only diagnosed after his mother, Claire, typed “child with persistent vomiting” into Google, and the HeadSmart campaign run by the Brain Tumour Charity came up. Claire told me that she did not for one second think that having a brain tumour  was even a possibility for children; it was not something that she had come across before. In fact, brain tumours are the single biggest cause of cancer death among children. Some 7,000 children and young people are currently living with the disease. Jack’s experience is not unique. Almost half of patients with brain tumours are diagnosed by emergency admission, compared with only 10% of cancers overall.
Jack and his family are strong, and they are doing everything they can to give him the best possible time in the time that they have. He was a mascot for Crystal Palace at Selhurst Park in March. Claire has other surprises planned, but I do not want to say what they are in case Jack is listening. Jack’s family have worked with the Brain Tumour Charity to spread the message that tumours exist; that people need to know more; and that we need to improve funding, data sharing, and developing new treatments. Claire’s message to this place is that her son cannot die in vain. That is a powerful call to action—and one that I know we will all hear.
It is knowing Tessa, having worked for her on the Olympics and since being her friend—she helped me get to this place and gave me massive support—that brought me to the issue we are debating today. There is something uniquely pervasive about cancer. But perhaps it is precisely because it is so pervasive that there is hope, because the battle is personal to so many people. That is why I am confident that, with the good beginning that the Government have made, real progress will be made today and beyond.
I know that the debate we are about to have will be difficult. People will be talking about their personal experience and the lives of their constituents. I know the debate will be comradely, because that is what Tessa would want—she always believes the best in people and never assumes the worst. I know that some of what we say will be hard. This will be an emotional debate, but one rooted in determination: for Tessa; for my dad;  for Jack.

James Brokenshire: I am very grateful to the Backbench Business Committee for enabling the House to debate these important issues this afternoon. It is a pleasure to follow the hon. Member for Croydon Central (Sarah Jones), who introduced the debate in such a powerful and effective way.
I do not think that anyone who watched Baroness Tessa Jowell’s speech could have been anything but moved by her powerful and poignant words. I know it moved me, having got to know, like and respect Tessa over many years for her work in Government and in the House, and for the way she is able to bring people together from across politics with a very constructive, focused and tenacious approach just to get things done.
The timing of Tessa’s speech also touched a particular chord with me, coming as it did just a week or so after my own surgery to remove a tumour from my lung. It was a brave, humbling and inspiring speech in equal measure, with her very personal description of her brain tumour and the impact it has had on her, her call to action to secure more funding for brain tumour research, and her stressing the need for more effective clinical trials and the joining up of analysis and data.
But fundamentally, what shone through in Tessa’s words was a profound message of hope—hope for the future; hope in the face of her own physical adversity—and her unstinting passion to secure positive change for the benefit of others. So many debates in this House or in the Lords, while passionate and important, can sometimes appear sterile, perhaps a little arcane, with discussions of statistics, policy or implementation of points of law. Tessa’s speech cut through all that to focus on the human condition: the life well led, what gives it meaning and purpose, and the overriding power of human kindness, compassion and love.
Tessa’s campaign has already made a difference. I warmly welcome the positive response from the Government by the Prime Minister, the Health Secretary and Members across Government to make change happen.

Jeremy Hunt: rose—

James Brokenshire: Perhaps I can give way to the Health Secretary on that point.

Jeremy Hunt: I am most grateful to my right hon. Friend. I wonder whether, on behalf of the Prime Minister and the Cabinet, I could follow the shadow Health Secretary in commending Tessa’s campaigning. Most people come to this place hoping to leave a legacy, but she has left not just one legacy, but two—her amazing achievements with London 2012 and her amazing campaigning on cancer. It is our privilege to take part in this debate and our duty to act on what she says.

James Brokenshire: I am extremely grateful to my right hon. Friend for underlining what can and will come out of this debate, which is continued momentum and a sense of purpose to bring about real change. Like the debate in the House of Lords, today’s debate should be a day not for political difference, but for how, together, we can all play our part in securing positive change to ensure that we use the best science to help beat cancer, and to offer the best support to those living with or beyond the disease.
After nearly eight years as the Member of Parliament for Old Bexley and Sidcup, this is my first opportunity to address the House from the Back Benches. While this is most certainly not a maiden speech, I hope colleagues will understand if I place some of my comments in a very local context. A few weeks ago, I was contacted by Lisa and Matt Taylor, the parents of young Olivia Taylor. In January, when Olivia was 17 months old, she was diagnosed with a large slow-growing glioma tumour, which is located at the centre of her brain. By February, Olivia had lost her sight and many other cognitive functions.
Olivia is no longer able to know whether it is night or day, impacting on sleeping patterns not just for her, but for the rest of the family. Because of its location, sadly the tumour is inoperable, and Olivia is receiving chemotherapy to keep the tumour stable and to help retain as much of her quality of life as possible. She is a very brave little girl and clearly surrounded by so much love.
As a parent, I find that a heart-breaking story, and the family face an incredible strain in meeting Olivia’s immediate needs and those that lie ahead. Despite all   this, I have been struck by their hugely positive outlook in ensuring that Olivia has happy memories and that she has access to all the right support. They have launched a campaign with the hashtag #KeepOliviaSmiling to help to raise awareness of the signs and symptoms of brain tumours in children and the need for early diagnosis.
Brain tumours are the biggest cause of preventable or treatable blindness in children and the family believe that if the signs of Olivia’s tumour had been spotted sooner, her sight might have been saved. The campaign is also intended to help raise funds to support future treatment for Olivia, which might not be available in the UK. The family have highlighted to me the need for better join-up between hospitals on available treatments, accessibility to international trials and the need for greater research in childhood brain tumours, which can develop in different ways from adult tumours.
I warmly welcome the additional £45 million investment in brain tumour research, which has been committed by the Government in conjunction with Cancer Research UK. I hope that in winding up the debate the Minister will be able to commit to ensuring that part of that funding is used to advance our understanding of, and deliver new treatments specifically for, brain tumours in children. Making a difference in individual cases such as Olivia’s is precisely what today’s debate is all about. I hope that, in some way, today we too can help to keep Olivia smiling.
There is no doubt that the science and analysis of cancer are advancing rapidly. Increasing amounts of patient data are being generated, as well as much greater recognition of the ways cancer develops and the individual mutations that can cause one tumour to behave in a completely different way from another. The challenge, as we heard from the hon. Member for Croydon Central, is co-ordinating the data in a consistent way that leads to more effective treatments and therapies.
One example of that is genetic analysis to help predict a cancer’s evolutionary path. I commend Cancer Research UK on its support of the innovative and significant work to examine the genetic make-up of individual tumours. I recently gave permission for a sample of my own tumour to form part of this molecular research. I hope that in some small way that might add to our understanding of the disease.
Such work is clearly leading to much clearer analysis not just of the nature of individual cancers, but of treatments and immunotherapies that are more likely to be effective for the patient. Rather than talking generally about cancer in a particular organ, we are increasingly able to talk about the nature of a specific tumour for that individual. That is a potential game changer, but it also raises new challenges and potential restrictions that must be overcome if we are to make the necessary progress.
I believe that the UK can be a world leader in this new era of precision medicine, driving forward innovative research to deliver new treatment options, but that will take time, when time for many is a precious commodity. That is why the use of adaptive clinical trials remains important. Yes, there are existing routes for new drug treatments to be made available, such as the early access to medicines scheme, and the cancer drugs fund, but we should be prepared to be more radical.
I pay tribute to the work of the incredible people in our NHS who deliver the care and compassion that Tessa Jowell rightly highlighted. They are amazing, and  having received significant NHS treatment and support over recent months, I know just how special they are. I also want to recognise the huge impact that charities such as Cancer Research UK, Macmillan Cancer Support, the Brain Tumour Charity, and the Roy Castle Lung Cancer Foundation have on the lives of thousands of people.
We need to do more as part of the broader cancer strategy, and I will return to a number of topics on another occasion, but we should be positive about what we can achieve, the difference that can be made and the outcomes that can be secured if we work together. In connection with that, some of Tessa Jowell’s own words from her speech in the House of Lords bear repeating:
“I hope that this debate will give hope to other cancer patients like me, so that we can live well together with cancer—not just dying of it—all of us, for longer.”—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]
That inspiring message is one that we should all take to heart.

Helen Hayes: I congratulate my hon. Friend the Member for Croydon Central (Sarah Jones) on securing this important debate, and I am grateful to the Backbench Business Committee for allowing it time. It is a pleasure to follow the right hon. Member for Old Bexley and Sidcup (James Brokenshire), who so powerfully shared his own experience of cancer and cancer treatment.
I pay tribute to my friend and predecessor as MP for Dulwich and West Norwood, Baroness Tessa Jowell of Brixton, who has inspired this debate. When I was selected as the Labour party candidate for the 2015 election after Tessa had announced that she was stepping down, four words seemed to come instantly to everyone’s lips as I went around the constituency speaking to people: “big shoes to fill”. They certainly were.
As a constituency MP, Tessa helped and supported countless individuals and families facing the most difficult of circumstances with compassion and tenacity. My strong memory of my first experiences of doorstep campaigning in the constituency is of how many people offered, unprompted, their gratitude that Tessa had helped them, often going above and beyond the call of duty. More than that, Tessa worked to deliver lasting change for our communities in Dulwich and West Norwood, by campaigning to secure investment to deliver not one, not two, but five brilliant new schools in the constituency. As a Labour Minister, she established the Sure Start programme, which was the fruit of her lifelong passion for supporting parents and babies to address disadvantage early and to enable every child to thrive. Sure Start centres made a difference across the country, including in Dulwich and West Norwood, where they are still highly valued by parents and carers. Through sheer inspirational determination, Tessa also delivered the greatest celebration of London and Londoners that we have ever known—the 2012 Olympics.
Across everything she did as our MP, Tessa established a clear and principled way of doing politics, based on listening to, engaging with and responding to the concerns of local residents; identifying and working on the issues  that matter to all of us and that bring people together; using the currency of personal stories, compassion and kindness rather than trading in statistics and cheap political shots; and, most of all, seeking to empower people and to tackle disadvantage and adversity head-on. It is therefore no surprise to Tessa’s many friends in Parliament, in Dulwich and West Norwood, across London and beyond that she is now using the very difficult personal circumstances of her brain tumour diagnosis to work to make a difference for other people in the same circumstances. It is no surprise, but it is remarkable in a situation where many of us would be focused only on our immediate loved ones, and it is extremely brave.
My own family knows the pain of brain tumour diagnosis. In 1983, at the age of 66, just a year after he had retired from his career as a bus driver and spent his life savings on a small house with an indoor toilet and a garden where he could grow his beloved dahlias, my grandfather George Hayes died from a brain tumour. Seven years later, in a situation so statistically rare that doctors had to be persuaded to take her symptoms seriously, my grandmother, George’s wife Olive, also passed away from a brain tumour, at the age of 71. We know as a family the fear and anxiety that such a serious diagnosis brings, the hopelessness of finding that there is very little that can be done, and the pain of watching loved ones deteriorate and lose capacity at the hands of such a cruel disease.
My first thought when I learned the horrible news of Tessa’s diagnosis was of grandparents George and Olive, and my second thought was that the treatment and prognosis for brain tumours must be much better now than it was then. I looked up the statistics, and was shocked to find that, although brain tumour survival rates have doubled since the 1970s, it is only from 6% to 14% compared with a 10-year survival rate of 50% across all types of cancer in the UK. Brain tumours kill more children and adults under the age of 40 than any other cancer, yet just 1% of the national spend on cancer research has been allocated to brain tumour research. As a consequence of this lack of funding, there is a shortage of drugs, and patient participation in clinical trials for brain tumour patients is extremely low—just 6.4% of adults compared with 61.4% for leukaemia. The survival rates for brain tumour patients after one year are less than 40%; after five years, less than 20%; and after 10 years, just 14%. Time is short for patients and their families.
Tessa has rightly called for more funding for research into treating brain tumours, but she has importantly also called for a more flexible approach to participation in adaptive trials. Such trials allow patients who have a diagnosis that without a breakthrough treatment will certainly be terminal to add new drugs to their treatment plan, or to switch between new medications in a trial rather than having to wait sequentially for each trial to conclude. They are really important. It is also important that better ways are found to share the data from brain tumour patients in order that it can be used for research. This is what most brain tumour patients want, and it is what most members of the public would want, faced with an illness that cannot be cured. Our experience and our data should be used to try to improve the prognosis for others in future.
Tessa has also called for improvements in the way that treatment is provided to brain tumour patients and the wider environment of care. There is still too much variation across the country in diagnosis, referral-to-treatment times, access to specialists and clinical trials, and palliative care for those who need it. We have in this country exemplary services in all of these areas, but they are not available to every patient. That must change. Everyone with brain tumour symptoms should be diagnosed as early as possible; be referred to a specialist centre with access to the most up-to-date surgical techniques and drug therapies; and have access to the very best support services, including counselling as well as physio and occupational therapy. If and when the time sadly comes, everyone should have access to the gold standard of palliative care, which exists in some parts of the country but which is currently not available everywhere.
I welcome the Secretary of State’s engagement with Tessa’s campaign for better research, access to clinical trials, treatment and care, along with the work of the brain tumour Task And Finish Group, Brain Tumour Research and others, but we must make change happen. It is our commitment, Tessa, and my promise on behalf of all those who love you in Dulwich and West Norwood that, collectively, we will take on your campaign, and that your vision of people living better lives for longer with cancer, and with brain tumours in particular, will become a reality.

Hear, hear!

Several hon. Members: rose—

John Bercow: Order. It may have to be reduced, but we will start with a limit on Back-Bench speeches of six minutes each. I call George Freeman.

George Freeman: May I say what a pleasure it is to follow the hon. Member for Dulwich and West Norwood (Helen Hayes)? She spoke with great passion and authority.
Thirty years ago this month, my father developed a cough and two months later he was dead from throat cancer. Being a man of that generation and age, he had never taken his health too seriously. He had never been for a check-up and had never received the care and treatment that would now follow, so what I say today is partly for dad. Eighteen months ago, I heard from a childhood friend of mine, Charlie Williams, that he had been diagnosed with the same form of brain tumour that Tessa has. Last week, Charlie posted on Facebook that he did not expect to see the next year out, so this is for Charlie.
I want to start by paying tribute to you, Tessa, for what you said in that remarkable speech. You spoke for us all, and to us all, and you spoke to the patients of this country not only with your condition, but with every other form of cancer—the patients I had a career working with who want us to make a difference for them. They want warm words, yes, and there were no words warmer than yours, Tessa, but they want us to turn the warm words into action. I believe that is the spirit in which we gather in this Chamber today, so this speech, Tessa, is for you.
Having come to this House after a career in medical research, it was my great privilege to be asked to lead, on behalf of the Government, a brain tumour research debate in Westminster Hall two years ago. I say this without a shred of criticism of my officials, who were simply doing their job, but the speech that I was given to read out said, as diligent speeches written by officials so often do, “There is no problem here. Move along. Everything is in good shape. Money is limited.” I read it with great respect, but I also listened to my colleagues with great respect, because unlike officials, we are sent to represent the people who put us here. As Tessa spoke for us all, I think it is our duty to speak always for the people who send us here.
I surprised my officials that day by announcing, as Under-Secretary of State for Life Sciences, that we would indeed create a taskforce to look into brain tumour research, never thinking that 18 months later my great friend the Secretary of State would announce £45 million of extra funding, in addition to the extra funding that he has recently announced on prostate cancer. That is a sign that, if we listen and speak on behalf of the people who put us here, we can make a difference, which is what Tessa wants us to do on her behalf and on behalf of all those people who send us here and the many patients around the country who are more impatient than anybody.
As you and patient colleagues know, Mr Speaker, I had a career in medical research. I want to highlight three important parts of this debate, the first of which is the new models of research that are coming—I was involved in my professional career in developing them. Secondly, I want to highlight the importance of patient voice in that model, and thirdly the importance of bold reforms to accelerate access to new treatments for our NHS patients.
My right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) referred to precision medicine. The truth is that the life sciences sector that I joined 25 years ago is undergoing a profound transformation. The sector that I learned about was basically in the business of making blockbuster medicines that work for everybody. It would start with a theoretical drug target and, after 15 years, $2 billion on average and an 80% failure rate, drugs would be developed and eventually brought through regulation to the all-too-patient patients who were waiting for the approval.
In the new model, based on the genomic information that we have and phenotypic hospital records, we are able to look at a population and know which are likely to respond to the drug and which are not. We can start with the patients that we know are likely either to respond or to receive the disease, which means that we can start with the patient. With patient consent, we are able to start with their tissues, their genetics and their hospital records, and we are able not to end with a patient waiting patiently for the system to authorise a medicine, but with patients volunteering up-front to be part of that research.
It has been my privilege in my professional as well as my political career to work with inspired NHS clinicians around the country who have been leading this model. I pay tribute to the work of Cancer Research UK as an organisation, but also to Harpal Kumar, whose leadership of that organisation has been transformational.
We should be inspired by the fact that breast cancer is now 95% curable. We are within living, touching distance of cancer being a preventable disease or a treatable disease. More than 800,000 people are now living and working with cancer: it is not the death sentence that is used to be. We are in the midst of the most phenomenal revolution led by cancer. We should applaud those involved and learn the lessons of how they have managed to do it, largely through genomics and informatics.
I will share with the House a story that illustrates where the value in the new model lies. During my last project before I came to Parliament, I was working with an NHS clinician who, at the end of the meeting, pointed to a shelf in his office and asked me, “Do you think there is any value in that?” I said, “What is it?” He said, “It is all the data from a £25 million study of 250,000 women at risk of gynaecological cancer, funded by the Medical Research Council and Cancer Research UK.” I said, “What have you got?” He said, “All the blood samples, all the genetic samples, and their patient records.” “That should be the Ageing Biomarker company,” I said. “We should form a company around that asset, because it will help us to identify ageing biomarkers.”

Steve Brine: May I place on record at this point the work that my hon. Friend has done to get us to this point? He is very modest in not saying too much about it himself—although he mentioned the Westminster Hall debate and the way in which he went out on a limb in response to it—but his understanding of the business and this fight has taken us a long way towards where we are today. I hope he can now conclude his speech as he needs to.

George Freeman: That is very kind. I take the hint from my hon. Friend.
The assets that we have in our health system are phenomenal assets to drive this research model, and I think it is our challenge to release them, but in order to do so, we need patient consent. However interventionist we are as Ministers, we as a system will not and cannot release data on tissues and genetics without patient voice. This research model requires us to empower patients and the charities that speak to and for them. I would like us to think about setting up disease portals in which patients can slide the consent bar on their phones, share their records, and help the charities to drive research.
Finally, we need to accelerate the uptake of innovative medicines in the system, which is what the accelerated access reform that I put together with my right hon. Friend the Secretary of State was all about. I dream of—I think we are within touching distance—a model in this country enabling the NHS to use its genomics and data to drive research. If we reform NICE to drive accelerated access, we give Tessa and the people for whom she spoke the legacy that they really want. We will make this country the leader not just of research, but of accelerated uptake of new treatments.

Steve Reed: I congratulate my hon. Friend and neighbour the Member for Croydon Central (Sarah Jones) on securing this  important debate, and on making what I thought was a remarkable speech. I remember her telling me, days after her election, about the loss of her father. It was such a keenly felt loss, but I know how proud he must have felt to see his daughter enter this place—I think he hung on to see that happen. Had he heard her speech—and perhaps he did—I think that it would justify every ounce of his pride in her.
I will start by paying tribute to Tessa Jowell, if I may. She was one of the Members of Parliament representing the London borough of Lambeth when I was first leader of the opposition and then leader of the council. She was a fantastic, supportive local MP. Despite her serious, significant roles in Government, she was always available to talk to me about my role and the community that we both cherished and loved and for which we wanted to do our best. She became my mentor, and she became my friend.
Tessa was always thinking about how we could do more to help people, particularly the most vulnerable. We worked together to open schools and Sure Start centres. I particularly remember that in the mid-noughties, when there was that terrible spike in violent youth crime and knife crime—similar to what we are seeing now—in Tessa’s beloved Brixton, where she had started her career as a social worker, she took me to see a community-led project called Exit on the Moorlands estate, one of the most deprived inner-city estates in the country, where there was a horrifically high level of youth engagement in violence. Young people knew by name others who had been killed, including friends.
Tessa took me to see that project, which had been set up by the community. It was supported by youth workers and the police, but with the community in charge, and it was making a dramatic difference to the life chances of those young people by getting them out of danger—getting them out of gangs and steering them back on to a safer path that was giving them back the future that should have been theirs as a birthright. Tessa took me to see that project not just because she wanted the council’s support for it, but because she was teaching me an important lesson: it was not my job as a politician to find the answers for people; it was my job as a politician to help people find the answers for themselves, because they would be better answers. I have brought that lesson with me into Parliament; like many of us, I would not be here if it was not for Tessa, and Tessa taught me that people-based politics.
That same compassion, empathy and drive to support and help people is what has led Tessa to turn this great personal challenge in her own life today into a way to bring about change to help others. For that reason, as well as many others, I am very proud to stand here today and support Tessa’s campaign.
As we have been hearing, brain tumour research is underfunded and undervalued compared with other types of cancer research, despite the fact that it kills more people under the age of 40 than any other type of cancer and is the biggest killer of children of any kind of cancer. So we need to match the progress made in survival rates for other forms of cancer, such as leukaemia and breast cancer, by focusing much more on brain tumour cancer and what we can do as a country and a society to help people who find themselves living with that form of cancer.

Joan Ryan: May I join my hon. Friend in paying tribute to the courage and bravery of our friend, Baroness Tessa Jowell, and particularly her significant decision to make her medical data available? Does my hon. Friend agree that, given the low level of participation in clinical trials, if we are to achieve much better results for patients, the Government and all of us must do much more to encourage participation in these trials in all of our local areas and in our national politics?

Steve Reed: I thank my right hon. Friend for that well-timed intervention. We absolutely need to boost participation in clinical trials. Only 6.4% of adults with this particular form of cancer take part in those trials, whereas over 61% of people with leukaemia participate, so there is a clear need for a major increase in the numbers participating in these trials if we are to get the data we need to learn. I join my right hon. Friend, too, in congratulating Baroness Jowell on her historic decision to become the first patient to consent to share her data fully and openly, in order to speed up the discovery of new cures and ways to help other people; she is an example to so many people in so many ways, but here again we need to learn from Tessa’s example, because that is how we will help to find a cure for this terrible form of cancer.
I say to Ministers, who will be responsible for regulation as well as funding, that it is important that regulation is not drawn so tightly that it does not allow for innovation and for new treatments to be developed. We must be open to doing things in different ways and to learning from failure as well as success; we cannot regulate against failure, but we can always learn from it so that we can improve.
We must increase the funding going into the kind of research that will find a cure for this form of cancer and put it on a par with other, perhaps more high-profile, forms of cancer that have attracted levels of funding that are making a bigger difference. In that respect, I put my name on record in welcoming and congratulating the Government on the increase in funding of £45 million —I believe that is the figure—announced since the very moving debate, which many of us attended in the House of Lords, led by Tessa Jowell.
Tessa has been a fighter all her life and now she is in the fight of her life, but how typical it is that she has turned it into a fight to allow others to live well, live better and live longer. Every one of us in this Chamber, and many others beyond, are proud to stand with Tessa today. I would like to say this to her, if I may: Tessa, you have all our love and all our respect. Please keep going and keep being the inspiration to all of us that you have always been.

Hear, hear!

Fiona Bruce: In the short time that I have to speak in this debate, I should like to focus on two areas. I want to talk about the important progress that needs to be made in the drive to fight prostate cancer and also, briefly, about the need for more attention to be given to the link between alcohol consumption and several cancers. First, let me say that I appreciate the fact that the Government are committed to improving the cancer services offered by the NHS, and to making  the UK a world leader in cancer research, diagnosis, treatment and care. Many innovations have been introduced, including the cancer drugs fund and the implementation of the independent cancer taskforce’s strategy. Cancer survival rates are now at a record high, and our access to the world’s leading cancer drugs continues to improve. However, there is always more to do, and that is certainly the case with regard to prostate cancer.
Prostate cancer is the most common cancer in men in the UK. It affects one in 10 men, so barely a family in the land will be unaffected. Indeed, my own grandfather died of it. More than 40,000 men were diagnosed with prostate cancer in 2016, and just over 10,000 men die of it each year. It is relatively rare in men under 50, but it gets more common as men get older, and the average age of diagnosis is between 70 and 74, which is often too late. It has been recognised that earlier diagnosis is the key. The Prime Minister and Health Ministers have considered what more can be done on prostate cancer, and they are looking at a range of options for further activity and taking expert advice. It is clear that the strongest chance of health gain lies in more research—particularly research that focuses on early diagnosis—together with innovative new treatments and care for men with prostate cancer.
I am pleased that, just a few days ago, the Prime Minister announced a very welcome £75 million plan to launch new research into prostate cancer. This will build on the already strong portfolio of prostate cancer research being done, and on the considerable investment that is already being put in. I know that the Department of Health and Social Care works closely with Cancer Research UK, Prostate Cancer UK, the Medical Research Council and others via the National Cancer Research Institute, which is a strategic partnership of the major UK funders of cancer research, and that the spending by that partnership on prostate cancer increased from £17 million in 2011-12 to £26 million in 2015-16.
As I say, more needs to be done, and the Government have indeed announced that substantially more will be done to help the thousands of men affected by this disease every year get treated earlier and faster. More than 40,000 patients will be recruited into prostate cancer studies over the next five years. Those studies will include trial testing, keyhole surgery, different types of radiotherapy, high-intensity focused ultrasound and cryotherapy. Other studies are seeking to identify predisposing hereditary genes, which could help to identify men at high risk, and this will include focusing on men with a family history of prostate cancer and also on black men, one in four of whom will develop the disease. Work will continue on supportive interventions, including exercise and dietary advice, and on the one-stop cancer shops being piloted in 10 areas to catch cancer early and speed up diagnosis, particularly for those suffering with less obvious symptoms. I appreciate the Secretary of State’s announcement that these plans will refocus the Government’s efforts to develop new treatments in this field.
I now want to touch on the link between alcohol and cancer. Over recent years the Government have exhibited admirable leadership by introducing a range of tobacco control legislation, helping people to reduce smoking, and they are now doing similar work to tackle obesity. Those are both high cancer triggers, and I applaud the Government for that work. Perhaps less recognised is the fact that alcohol can also be a cause of cancer.
As chair of the all-party parliamentary group on alcohol harm, I believe that this issue needs more attention from the Government, in the same way as they have looked at smoking and obesity. Indeed, consuming too much alcohol can increase the risk of at least seven types of cancer: bowel; breast; laryngeal, or cancer of the voicebox; liver; mouth; oesophageal, or cancer of the foodpipe; and pharyngeal, or cancer of the upper throat. Without being conscious about how much we drink, there is a risk that many people are drinking in a way that causes those cancers and that is preventable.
I ask the Government to do more to encourage people to drink responsibly to reduce cancer risks, as well as many other health risks. One way would be for the Government to help people better understand what 14 units a week, the amount in the chief medical officer’s guidelines, really means. I also ask the Government to meet me and the all-party group to discuss improving the labelling of low-alcohol and non-alcoholic drinks. That would do much to help change habits, promote responsible drinking and prevent cancer and other health risks that can come from drinking even slightly above the chief medical officer’s guidelines.

Peter Kyle: Thank you, Mr Speaker, for being present in the Chamber today. I know that you take the Chair most Thursdays, but I choose to interpret your presence today as a testament to Tessa. He is not in his place at the moment, but it is worth recognising that the Secretary of State was present not just during today’s debate but in the debate in the Lords. That was recognised by many of us and very much appreciated.
I want to start by talking about my mum, Joanna Kyle, later Murrell. In 2011, my mum presented to doctors with severe back pain, for which she was given medication but no further tests. In the 18 months that followed that visit, she went to doctors and clinicians and to hospital no more than a dozen times with the back pain, which never went away and only got worse. She was sent for numerous tests on her back, but on her final visit to the GP, when her husband said, “Please run more tests because the pain is not going away,” the GP simply replied, “Why on earth would I do that?” A week later, my mum collapsed. She was taken to hospital and diagnosed with stage 4 lung cancer. Within a month, she had died. Her mother had lung cancer, my mum had been a smoker earlier in her life—one would have thought that those were the sort of things that would have been picked up much earlier.
At the point at which my mum was diagnosed, she had only a 21% chance of living a year. If she had been diagnosed at the point at which she first presented to the doctors, in all statistical likelihood she would have seen me, her son, enter the House of Commons. There would have been a very good chance that she would have been here today or, most likely, outside enjoying the weather at her house in Devon.
My mum was not a complainer. She did not push herself forward, and she did not complain, thrust or make sure she got all the attention she needed. This is a good link from my mum to Tessa. Many people who do not know the relationship I have with Tessa might not  see the link between my mother and Tessa, but for me it seems very logical. Tessa has always played a very strong and maternal role in my life, always—always—pushing me forward. For me, the link is an easy one. Tessa, too, is not a complainer, but my God she is a doer. She has always got things done and it is easy to pay tribute to her not just for her stellar career and achieving the Olympics but for her wonderful family. These debates in Parliament are the best testament to her, because amid the anguish of living with cancer, Tessa’s first instinct is to make life better for others.

Tanmanjeet Singh Dhesi: Does my hon. Friend agree that although we pay tribute to the incredible bravery and determination of Baroness Tessa Jowell, we also need to pay tribute to the amazing work of Cancer Research UK, which has an impact not just in our country but around the world?

Peter Kyle: Of course I do. My hon. Friend makes an important point. Tessa, too, has been linking with many organisations, bringing them together and focusing attention on them but, just because that is so typically Tessa, it does not make it any less remarkable.
For brain cancer to be tackled, three things must happen. We need to sort out funding, innovation and the use of data, and I will speak about the data. The working group set up by the Department of Health and Social Care said that brain tumour patients would like
“their health data to be used for research to speed up development of new treatments. Regulators should respect these wishes.”
Lord Freyberg said in the debate in the other place that Britain has a “globally unique research asset” in the NHS. We have cradle-to-grave records covering millions of people, and examples from those records could revolutionise care and research. Those records need to be much better utilised.
That is the data at the very top, but we now see in America how Apple is revolutionising the use of health data down to the individual. Last month a dozen healthcare providers in the US partnered with Apple to provide health records directly on to patients’ phones via an app. The information is presented in a way that incentivises healthy choices and empowers patients not only to make the right choices but to have a more natural relationship with their health and health information, and with the professionals who provide it. With our NHS, we have infinitely more potential than any other country on earth to revolutionise health research and the way we manage and maintain our own health. We need far more ambition to realise that.
I end with another quick word about Tessa, because I would not be here if not for strong women like Tessa pushing me forward way before I came to this place and way before I got into politics. In all those situations I knew Tessa and felt her guiding hand gently pushing me forward. She gave me the kind of mentorship that people need. I have articulated to her many times that it has always been a source of regret that we were never able to sit on these Benches together, because I believe hers is the sort of mentorship from which somebody like me would really benefit as they enter this place.
Tessa, to be here today in the same Chamber as you, and to be sharing these green Benches with you for these few moments, is something I will remember for the rest of my life.

Kevin Foster: It is a genuine pleasure to follow the quality of speech we have just heard from the hon. Member for Hove (Peter Kyle). He may not know it, but we are similar in both having lost our mothers to cancer.
My mother, Linda, was diagnosed with bowel cancer back in March 2011. By that point the cancer had spread to her liver and lungs. She had a couple more good years with us, but she had reached the point where, despite all the treatments, the cancer’s progress could not be stopped. She was very stoic in the face  of it.
I was a councillor at the time, and my mother knew I had to take time away from my duties. I remember her saying from her hospital bed, “You do know you can tell people about it?” That was quite a decision for her, because she was usually quite a private person—she was always the person in our family who was not ill or unwell. She did not usually want to talk about her issues, but she was clear that I should talk and tell people about it: if people saw my position, I would get publicity and people would want to know why I was away. The idea that I was spending my weekend with my mum and my family is very different from the idea that I was helping my dad care for my mum when she had just come back from hospital.
All the way through, my mum was keen that her experience should be talked about, and she would be pleased that, even today, it is still being mentioned, because she wanted people who have a suspicion to go and get a test and to find out about it. It is better to find out than to worry and not do it.
My mum was 56 when her cancer was picked up in March 2011, and the irony is that my father had been 60 the year before and they had received the bowel cancer test kit for him in the September or October. He dutifully did what he needed to do with it in the bathroom and sent it back. Of course, it came back clear. Had my mother used the kit, it may well have been a very different scenario. The key thing that came out of it for me is that her tumour was located up, over and right the way back down in her bowel, so the more visible signs did not show. There would have been no blood in the toilet because the blood would have dissipated through her system. But a test would have picked it up, which is why it is so important to me that that message is heard, because people do sometimes think this might be embarrassing and find that when they read the instructions of what to do with the test it sounds a bit odd. There is nothing to worry about. People should not just use it because they are feeling ill; they should use it because it is there and it can tell them that there is something wrong.
The Minister spoke briefly to us before we came into the Chamber and I hope, given my family’s experience, that real consideration is being given to how the faecal immunochemical test can be expanded and, thus, help save more lives, particularly among the under-60s. The fact that this was started at 60—it was a good initiative, which has helped saved lives—almost sent a message of, “Well, when you’re 60 you might get this”, whereas plenty of people younger than that get it. Sadly, my mother passed away from bowel cancer at 59, before the age at which she would have got the test in the post in order to try to identify whether she had the illness.
My mother’s case highlighted one other thing, which we have seen in other cases: once a doctor has concerns, it is important that we can get the tests done quickly to identify exactly what is wrong. With my mother, it was unexplained anaemia and stomach pain that finally triggered the test to be done, but it can be all sorts of complaints. The hon. Member for Hove (Peter Kyle) gave the example of something being wrong but we cannot quite pin down what. I know the ACE—accelerate, co-ordinate, evaluate—centres are being created, and I am interested to hear the Minister’s comments about how he thinks they can be expanded and developed. Where a GP has a concern with a patient—where something seems to be not quite right but they cannot put their finger on exactly what aspect of cancer it might be or whether it is cancer—we need the ability to get the tests done and a diagnosis made quickly, which then means treatment can start.
It is absolutely right to say that cancer is not the death sentence it once was and it is not taboo to talk about it, as it once was. The only thing my mum hated was when anyone called it “The big C”. She said, “Oh, for goodness’ sake, if you are calling it ‘The big C’ you might as well say what it is. What a load of nonsense!” That was her reaction; she wanted us to call it cancer, because that is what it is. She used to say, “Look, I’ve got bowel cancer. It is not bowel with the big C. It is bowel cancer.” That was very much her view. For some people, that description helps but for her it gave the idea of not being up front about what it is and this was about being able to get treatment. So I hope something good can come out of her experience.
Thankfully, more people are surviving cancer than used to be the case, but this sort of debate is so important. I say that, first, because it brings this up and it is about sharing personal experience. No one is immune from cancer. I know my family history and I know that in my mid-50s there are some tests I need to have. My mum was worried that I might have her genetic condition and so be more liable to get this, but I just said to her, “Well, if it is, the one thing we can guarantee is that I am going to be one of the monitored people in western Europe for that particular condition. Don’t be embarrassed about it, mum.” This was certainly an informative experience for me, and I do hope we can do more. I hope that the result of this debate is that more people can be helped and we can get the death rates down even further.

Heidi Alexander: It is a genuine privilege to speak in this debate, and I congratulate my hon. Friend the hon. Member for Croydon Central (Sarah Jones) and the right hon. Member for Old Bexley and Sidcup (James Brokenshire) on securing it. It is entirely appropriate that this debate has been led by two south London MPs. As a fellow south Londoner, may I start by saying what a special place in our heart is occupied by the very noble Baroness Jowell? There are some people we meet in life who radiate positivity, and Tessa is one of them. She has a lightness of step but a firmness of view that is a formidable combination; there was no way those Olympics in 2012 were going anywhere but London! It is right and proper that this House has the chance to debate her latest and perhaps most important campaign: the need to increase research on, and improve outcomes for, individuals diagnosed  with brain cancer. The figures on research funding, and the availability of effective drugs and treatment, speak for themselves, and I will not repeat them, as I know time is short.
Last year, I lost two people close to me to cancer. One was my father-in-law, Nigel Ballantyne. I hesitate to say what I am about to say, as I have questioned whether my own grief has skewed my perceptions of the care that he received. I do not think it has. I also hesitate because I wonder whether today is the appropriate time to raise these issues, but I have concluded that Tessa would not want me to pull any punches.
My father-in-law was told that he had lung cancer when he was on his own, in a hospital bed, with only his mobile phone for company. There were complicating circumstances, but there were no excuses. He had struggled to get an appointment to see his own GP and had been passed from pillar to post for months—a situation admittedly not made better by the usual reticence of a 76-year-old man not wanting to cause a fuss, and his understandable desire to go on that holiday that he had been looking forward to. Having said that, the delay in his diagnosis and the way his diagnosis was delivered were unacceptable. He died six days before the general election last year.
Five months later, a good friend died at home after a long struggle. His wife speaks of how she had to fight tooth and nail to get palliative care support in place on the night he died. She described to me a ward that lacked sufficient nursing staff to administer injections without her physical help.
When the national cancer strategy talks about placing patient experience on a par with clinical outcomes and quality of life, it rings a bit hollow to me. I do not want to sound overly bleak, as I know that there are many wonderful examples of good care with positive outcomes, but we do need to be honest. We need to ask ourselves tough questions about how patients are treated on all steps of the care pathway.
Those living with cancer also need more support. Last Friday, my constituent, Amanda Mahoney, whose breast cancer has recurred four times in seven years, came to my advice surgery to ask me to campaign alongside her to change the face of cancer. She said:
“We’re not all bald, we’re not all having chemo. I don’t want to be told ‘sit on a park bench and wait till it gets you.’”
She wants to continue doing the job she loves—she is an outreach worker with autistic children—but her recurring experience has been employer after employer who does not know what to do and a benefits system that seems to make things harder, not easier.
This issue is not going away. This debate is the product of Tessa’s campaigning. She has been able to do what she does best—make her contribution by making those in power sit up and listen. She has been able to continue her working life. Others should be able to do the same, if that is what they want, and employers should be supported to make that happen.
There is so much more that needs to be said, but in the time available it is impossible to do this subject justice, so I will touch on just one other issue, which I know is also close to Tessa’s heart: our impending departure from the EU, which includes our probable departure from the European Medicines Agency and  Euratom. Promises were made about extra cash for the NHS after Brexit, but, in stark contrast, Brexit has potentially huge negative implications for cancer research and treatment. We need urgent answers.
The continued ability of British cancer sufferers to participate in pan-European clinical trials is critical, especially for those with rarer cancers. We must ensure that we have a reliable supply of medical isotopes for diagnostics and treatments—that supply is at risk as we leave Euratom. We must not become a second-tier country for access to the newest and the best medicines. The next generation of immunotherapies holds great potential. We cannot willingly put ourselves at the back of the queue.
There are not yet answers to those questions, nor are there answers to the chronic NHS staffing crisis, which is exacerbated by Brexit, yet we are 11 months from leaving. We need a global, cross-border approach to research. We need to be a country that is open to talent and ideas from around the world. We need a properly resourced, adequately staffed NHS that is capable of embracing innovation.

Wes Streeting: Will my hon. Friend give way?

Heidi Alexander: I am drawing my remarks to a close.
It saddens me that we seem a long way from that aspiration, but if we are to honour the work of people such as Tessa and the memory of people such as my father-in-law, it has to be worth fighting for.

Rachel Maclean: It is a real pleasure to follow the hon. Member for Lewisham East (Heidi Alexander). I join other colleagues in congratulating the hon. Member for Croydon Central (Sarah Jones) and say that it has been a real privilege to take part in this debate. She has achieved something that we often talk about, but today’s debate has highlighted it, and that is that we really do have more in common. Absolutely everybody in this Chamber will have experienced cancer or its effects at some time in their life. We are all touched by it; it has its own dark logic that spares nobody.
In my research on the debate, I was struck by the fact that cancer has been around since 4600 BC. That was highlighted in the excellent book “The Emperor of All Maladies”, written by oncologist Siddhartha Mukherjee. He wrote the book to help his patients understand what they were fighting. This disease lived in silence until 440 BC when Herodotus recorded a slave removing a tumour from the breast of her mistress. We do not know whether she was successful, but, clearly, things have moved on considerably since then. However, what has not changed is the devastation, pain and suffering caused by cancer.
I find myself in the presence of someone who has been talked about so much—Dame Tessa Jowell. It is a real honour that she was the one to spark this debate, and I and my colleagues pay tribute to her for the fantastic work that she has done. I hope that we will see some real progress.
Brain tumours have touched my life as well. My son’s classmate, Joseph Foote, lost his life in August 2007. His father went on to found a brain tumour charity, which  raised £2 million. He was a real inspiration in our local community. Every single year, as my son gets older and has his birthday, we are aware of the hole in his classroom. When I got involved with the efforts to raise money, I was surprised, like the hon. Member for Croydon Central was, to learn that, of all the cancers, brain cancer was the most common killer of children—I did not know that. The charity has now been merged with the Brain Tumour Charity, and it continues to work really hard.
Of course, there are many other charities. I am delighted that I have been able to support Breast Cancer Now as an ambassador. I will not speak at length about the charity, but it welcomed the launch of the cancer drugs fund in 2016. I thank the charity for the excellent brief that it provided today, and ask whether the Minister will set out the terms of reference for that cancer drugs fund review. We understand that it is under way, and the charity has asked how patient organisations will be involved.
Let me turn to my local hospital, the Alex, part of the Worcestershire Acute Hospitals NHS Trust, which I have mentioned many times in this Chamber. I continue to work closely with the trust. With regard to cancer, I am concerned that our statistics are falling short of a number of key national targets. The trust is still in special measures. It has, unfortunately, let down many of my constituents in the past with long waiting times. That is not good enough, but new leadership is in place. It is beginning to make a real difference in turning around the situation, and that is down to the efforts of the incredibly hard-working frontline staff, and I pay tribute to them.
I have visited the cancer ward at the Alex and seen the chemotherapy that is going on there. I have seen at first hand the care and compassion that the staff display, and I know that it makes a real difference to the people of Redditch at that time in their life.
On cancer statistics, the trust is failing to meet some national targets. There are signs of improvement, which I welcome, but I have a question to put to the Minister and also to my right hon. Friend the Secretary of State, who told me when I was first elected that our trust was one of the trusts he was most concerned about. I call on him to make sure that he continues to keep it at the top of his list, and continues to keep it in his focus, because we want it turned around not just for cancer treatment, but for all the treatments that take place there.
There are some good-news stories for the trust. We have seen some new investment in the form of a new testing service, which has been introduced just recently. Breast cancer patients are benefiting from drastically reduced waiting times, thanks to a test now carried out in the labs at Worcestershire Royal. This has cut the time doctors have to wait before deciding what treatment to give patients from three weeks down to two days.
Tests used to be sent to Birmingham, which meant long waits and added cost, and doing them in-house has massively reduced the time taken to produce the results. That means that doctors can decide the best course of treatment as quickly as possible. In particular, this improves the prognosis for patients with certain types of breast cancer. I hope people begin to see that things are slowly improving, but we must never let the trust slide back again, because my constituents deserve world-class services in cancer and in all other health services.
We all know how important it is that cancer treatment starts early, which is why I welcome today’s contributions. Facing a cancer diagnosis and not knowing how long one has to live must be the worst experience that can happen to a human being. As those brave souls fighting cancer know better than us, it is not about counting  the days; it is about making every day count—it seems that Baroness Tessa Jowell is definitely doing that. I am pleased the Government are unwavering in their commitment to the resilience of the human spirit and have made cancer their compassionate priority.

Tulip Siddiq: Seb Coe described her as “Mary Poppins in stilettos”. The Guardian called her “the ultimate loyalist” and many times rehashed the image of tiny Tessa Jowell throwing herself dramatically under a bus—presumably a London bus. Alan Johnson said she had
“all the warmth in the world but a core of absolute steel”.
The Evening Standard said:
“If you cut her veins, you would probably find the River Thames running through them.”
Google Maps decided to get involved and made her a London landmark, placing her between Big Ben and Westminster Hall—most apt, I think.
For me, Tessa Jowell, whom I worked for once, will always epitomise the best of my city, London. She has long been a professional and personal hero of mine. At one point, we were both Camden councillors, although she has achieved a lot more in her life than I ever will. As all Members have already mentioned in this powerful debate, it was Tessa who was fundamental to bringing the Olympics to London; it was Tessa who constantly talked about how we had to go all out to win and about how big prizes were never won by playing it safe; it was Tessa who said the Olympics would teach us Londoners to be resilient and to celebrate our diversity; and it was Tessa who told us the Olympics would show us the extent of our ambition. How right she was.
In the same spirit that Tessa has talked about her medical condition—the cancer that resulted in her having two seizures in a cab, about which she has spoken so powerfully—and with the same resilience, she has said she will use her experience to make life better for others and improve and lengthen the life of cancer victims. She has shown the same ambition in talking about using innovative cancer treatments that do not currently exist in the UK.
Tessa has inspired me to suggest that we in the House work together to launch an initiative similar to Dementia Friends. For those who do not know, Dementia Friends is an Alzheimer’s Society initiative that offers extensive information sessions so that people can learn about dementia and what they can do to help. The sessions play a crucial role beyond recognising just the signs of dementia, not least because the way dementia affects people varies hugely. I know we already have brilliant organisations such Cancer Research UK and care organisations such as Macmillan, but the role of a cancer friends initiative would be different. It would be more about understanding the medical condition, building resilience through networks and creating cancer friendly communities. Formalising such body could support  many thousands.
Having worked with Tessa, I know she has a strong support network, like no one else, of friends and family, but not everyone has that, as she will be aware from our conversations about loneliness—an important subject put on the map by my late friend, Jo Cox. Tessa would be the first to agree that because not everyone has these networks at their fingertips, it is necessary to consider launching a cancer friends initiative. Such an initiative could also bring profound benefits for those searching for stem cell donors.
I want to mention a constituent of mine, Lara, who has been very brave in the face of adversity. She had a similar condition, but was unable to find a stem cell donor because of her black, Asian and minority ethnic background. If people look into the figures, they will realise that only 60% of patients receive the best match, but if they are from a BAME background, that drops to 20%.
I raised the case of my amazing constituent Lara at Prime Minister’s questions, and I talked about the spit drive we had at the O2 Centre in my constituency. Lara actually managed to find a match and is undergoing treatment because of the network that came around her and the community in my constituency that helped her. A cancer friends initiative could certainly help to spread the word.
I want to talk about Hampstead and Kilburn—I think Tessa would approve of me bringing in my constituency, because she happened to mention her constituency every five minutes when we worked together. My constituency is blessed with some of the finest oncologists in the world. The Royal Free Hospital, which everyone will know about, is a European centre of excellence and is celebrating the 20th anniversary of its neuroendocrine tumour unit. It has grown from having 30 patients to having more than 1,800, and it will soon be joined by the Pears Institute, which will be one of the five leading centres of its kind across the globe, bringing clinicians together to research revolutionary new cancer treatments. Hospitals such as the Royal Free have benefited enormously from Tessa’s work in Camden, where she started out, but, as we know, her work has touched the whole country.
In 2015, Tessa gave a memorial lecture to mark 10 years since the 7/7 attacks. She said:
“This city, this country, this people are a model of resilience… Resilience is rooted in optimism. Behind the strength to stand firm lies the feeling that tomorrow will be better than today… Resilience relies on a commitment to our way of life but also the feeling that life can improve. Progress is not an illusion even in the darkest of hours.”
Tessa was talking about British people, but her words are a perfect testament to the character she has shown in fighting, even after she left these green Benches and was elevated to the red Benches. A model of resilience, a model of optimism, a model of a politician—our Tessa Jowell.

Wes Streeting: I rise today to talk about some very special people with an Ilford North connection. Perhaps even more impressive than crossing the party political divide in this debate, Tessa Jowell crosses an even greater political divide in London—  the River Thames. I say respectfully to my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and her constituents that we actually had Tessa first, because, in 1978, a fresh-faced Tessa Jowell embarked on a by-election campaign there. She was defeated, obviously, by the great tides of national politics of the day but, undeterred, she persisted in 1979.
What was so remarkable when I shared the video of Tessa Jowell speaking in the House of Lords in that powerful debate on cancer was just how many of my constituents responded, not just with great love and affection, but with strong memories of meeting Tessa during that by-election 40 years ago. That speaks so strongly of the warmth, empathy and infectious personality that Tessa has brought to her politics. As so many people have said, that certainly made its mark in so many ways on public policy in this country, but anyone who has ever met Tessa has been personally affected by her, and that is why we are all here today, determined to carry forward her legacy in such an important area.
I also want to talk about my constituent Kaleigh Lau. Today is a very special day for Kaleigh and her family—her father Scott, her mum Yang and her brother Carson. Two years ago today, Kaleigh was diagnosed with a diffuse intrinsic pontine glioma, or DIPG, which is a brain tumour located in the pons of the brainstem, for which there is currently no cure. At the time, Kaleigh and her family were told that life expectancy with DIPG was just nine months and that they should focus on making memories. Well, last month, Kaleigh celebrated her eighth birthday, and two years on from that awful day Kaleigh, her family and her huge band of friends and supporters are determined to make history, not memories, as they battle to defeat DIPG.
Their journey during the past two years has not been easy. I have followed the family through their tremendous ups and downs: the 30 radiotherapy sessions that young Kaleigh experienced between April and June 2016; that awful moment in December that year when Kaleigh was in progression, eight months in; the closeness with which Kaleigh almost got on to the convection enhanced delivery treatment programme through the compassionate treatment route, only to be told at the eleventh hour that the tumour had spread and CED would no longer be possible; the 10 more radiotherapy sessions that she underwent in January and February 2017; and the moment when Kaleigh’s condition declined to such an extent that the family took her on what they thought would be her last holiday, in March 2017.
Today is also an important day for the family because things changed a year ago today when Kaleigh began experimental treatment in Mexico. By her second treatment, she had regained all her functions. Five other UK families followed her to Mexico. Kaleigh was the first European to receive this treatment. More than 50 people around the world have now undergone the same treatment. None of this has been easy and we do not yet know whether this experimental treatment will be successful, but we know one thing for sure: if Kaleigh had stayed in the UK, she would not be with us today.
Kaleigh’s family have spent over £250,000 to fund her treatment so far, and her ongoing treatment costs them £15,000 every four to six weeks. I pay tribute to Kaleigh’s remarkably resilient family, particularly her father Scott, with whom I speak regularly. Scott has a full-time job and is a full-time dad. He is an utterly selfless human being,  to such an extent that every time I call him back, without fail his first words are always, “Thanks for calling. I know you must be busy.” I am nowhere near as busy as Scott is, as a father trying to look after and care for his family on top of everything else that they are dealing with. This is why I address my remarks to Ministers.
I thank successive Ministers—most recently Lord O’Shaughnessy—for engaging with Kaleigh’s case, but they will understand the family’s frustration. After three meetings with the Department of Health, two online petition campaigns and a huge fundraising effort to pay for Kaleigh’s treatment, they do not feel that things are really moving forwards. As Scott says:
“How is the UK government going to help Kaleigh now? Not in the future, but now? Without funding we have no treatment. Overnight we have been forced to become an expert on DIPG, a carer, a fundraiser, a counsellor, an adviser, a leader, a beggar. But ultimately we need help from our government to take the burden off us so that we can focus on Kaleigh.”
There are just a few things that I want to say to Ministers in the short time I have left. We need to become a global leader in tackling DIPG, which has already taken over 200,000 children. We can do this through research, spearheading clinical trials and ensuring earlier access to treatment. We need to do more to ensure financial support to access experimental treatment. I understand the ethical dilemmas, particularly where experimental treatment is concerned, but we have to place greater trust in patients and parents who are willing to take risks.

Siobhain McDonagh: I am sure that everyone in the House is paying rapt attention to my hon. Friend’s explanation of Kaleigh’s care and determination, and that of her family. Will he conclude the story and tell us what is going on at the moment?

Wes Streeting: I am so grateful to my hon. Friend for that additional time.
If Ministers cannot fund treatment, let us at least look at funding the flights, accommodation and all the additional costs that families face. It was remarkable listening to the comparison between what Tessa has been through and what Kaleigh’s family have been through in this respect. We need better care plans, advice and guidance. Scott has to do it all himself, to such an extent that he has become an adviser to families around the world on top of looking after his own children. We need to do a lot more to ensure consistency.

Caroline Flint: My hon. Friend is coming up with some practical suggestions and creative ways of supporting such families. Does he agree that it is important that the NHS thinks sensitively and creatively about how it can support aftercare once Kaleigh and her family come home?

Wes Streeting: That is absolutely right. I pay tribute to Great Ormond Street Hospital and other great NHS services that have supported the family.
As my hon. Friend the Member for Croydon Central (Sarah Jones) said when she opened the debate, we have all been affected by cancer in some way. The worst experience of my life was losing my nan to cancer when I was aged 10. It is a great source of regret to me that I do not still have that great left-wing firebrand who  occupied County Hall when Mrs Thatcher decided to shut it down, and allegedly threw a brick at the trucks as they rolled into Wapping. Some of that has rubbed off on me.
I hope that, in looking at what we can practically do to support families, Ministers have heard the powerful contributions made today. I want to say to Kaleigh’s family, to Tessa, and to other families who have been affected by childhood brain tumours that their strength, their courage and their resilience, but most remarkably of all, their enormous generosity of spirit in seeking to help others while they go through an enormous struggle themselves should be an example to us all. Tessa, that is the example that we are following today, and we are determined to make sure that our country gets this right for you.

Siobhain McDonagh: I cannot compete with some of the wonderful speeches that have been made today. My research would be perfunctory by comparison with some of the things that Members of the House have told us. I will leave this debate knowing so much more about brain cancer than I did when I arrived.
My purpose in speaking is simply to say to Tessa: we are with you. You know, Mr Speaker, that politics is a rough old trade, and sometimes you fall out with people—people you think the most of. I just wanted to be here to say to Tessa that whatever the arguments or disagreements, it counts for nothing by comparison with my admiration and my determination to do anything I can to support her in her campaign.

Joan Ryan: Let me grab this opportunity to say something, because I am sure that Tessa can see that she has got these three women here—me, my right hon. Friend the Member for Don Valley (Caroline Flint), and my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh). We entered this House in 1997 and joined Tessa Jowell on the Government Benches, and we served with her through three terms of the Labour Government. She gave us such fantastic support. I just wanted to leave a rounded picture of Tessa in this very serious debate. I bet she is really a little bit embarrassed at all the praise, but she deserves it. She is such a strong supporter of women coming into this place and getting them through the process to get here. She also has a very ready but very kind wit that we witnessed much of when she was at the Dispatch Box.

Siobhain McDonagh: I thank my right hon. Friend—my very best right hon. Friend in this House—and Members can see so many reasons why that is.
Sometimes we fall out, and perhaps we fall out harder on our own side than we do with parties on the other side. Tessa is extraordinary in her example, as are so many people, particularly in the NHS. At 7 o’clock tonight, I will be holding a reception in the Jubilee Room of the House of Commons for the winter heroes from Epsom and St Helier University Hospitals NHS Trust to say thanks to them. If anybody wishes to join us, there will be a glass of wine and a packet of crisps for them. Thanks to the NHS, thank you to Tessa, and thanks to everybody for their brilliant speeches today.

Jim Shannon: It is always a pleasure to speak in any debate, but especially one on cancer. First, as others have done, I congratulate Baroness Tessa Jowell. I see her not in stilettos but as a real soldier and a real warrior. I thank her for her courage and determination. I thank the hon. Member for Croydon Central (Sarah Jones) for setting the scene. To pick out one speaker in particular, with no disrespect to anyone else, I thank the right hon. Member for Old Bexley and Sidcup (James Brokenshire) for his contribution. What a joy it is to see him back in the Chamber again making a valuable contribution, as he always does.
This is always a tough kind of debate to speak in, for a number of reasons. We rightly all use the statistics and numbers that are so informative, but tend to gloss over the pain felt by the families and loved ones. We rightly talk about how far we have come in terms of greater life expectancy, and yet those families who watch this debate with an empty chair beside them cannot share the victory. We are rightly bombarded with requests from charities and families asking us to highlight their particular issue that needs to be addressed. We want to do that, yet we do not have the time to discuss all that needs to be discussed. We rightly discuss value for money in funding research, yet which one of us is comfortable in putting a price on the cost of the quality of life for someone, and which one of us is happy to dictate a cut-off age when someone is too old to be treated or given innovative new drugs? We all seek to do what is right and to do our best, but it can never be enough when it comes to a debate like this. My father is a three-time cancer survivor. He did not die because of cancer—he died three years ago of natural causes. His survival from cancer was down to the good work of the NHS, the skill of the surgeon and the care of the nurses—and it took all of our prayers.
I highlighted in my own press release background information from Brain Tumour Research, which was probably in the paper today. I recently had a photo with a lovely lady called Phyllis Scott, with whom I have had a great friendship over the years, in aid of raising awareness of brain tumours—I know that that is close to the Minister’s heart. I wore my country sports hat for the purposes of the photograph, and today I am wearing my MP hat to look at the issue of brain tumours.
Brain tumours reduce life expectancy by, on average, 20 years—the highest of any cancer. The statistics are well known. In Northern Ireland, 344 people were diagnosed in the last year. Some 60% of people diagnosed with a high-grade brain tumour will have a very short life in this world. The figures are shocking, but when we meet someone like Phyllis Scott, the human face is very clear. Some 62% of children who survive a brain tumour will be left with a life-altering, long-term disability. Brain tumours are the biggest cause of preventable or treatable blindness in children, as the right hon. Member for Old Bexley and Sidcup pointed out. Some 91% of adults said that their brain tumour affected their emotional and mental health. Those are the key figures—many of those diagnosed with brain tumours have tremendous issues.
I love the hard-hitting new Cancer Research advert that shows an older couple in bed together as a stark reminder that the issue is not simply surviving, but living with a husband or wife and children. The hon. Member for Redditch (Rachel Maclean) spoke about being a breast cancer champion. I am one too, and I  very much wanted to do that. The number of people diagnosed in the UK went up by 17% between 2006 and 2016. Some 95% of women will survive one year and more than 80% survive five years or more. None the less, every year around 11,500 women and 80 men in the UK still die from breast cancer.
I have asked the Minister about the drugs fund many times, and so many other hon. Members have mentioned it that it would be remiss of me not to do so. The threshold is £30,000, and the hon. Member for Ilford North (Wes Streeting) mentioned putting a price on the drugs that help a young child survive. In Northern Ireland, the Department of Health, Social Services and Public Safety has now endorsed the NICE recommendations on Kadcyla, Ibrance, Kisqali and Perjeta, as a result of the flexibility shown by NICE, tough negotiation by NHS England and willingness to compromise on price by the pharmaceutical industry. However, this flexibility, negotiation and compromise can lead to long delays in decisions. I urge the Minister to consider how we could best provide access to drugs more quickly and urgently to increase the quality time that people have to spend with their loved ones.
I want to put on record my thanks to Cancer Research, Macmillan, Marie Curie and others that make the difference to the quality of life that those who suffer from cancer experience. We must push forward and keep doing all we can, and know in the end that we gave all we had to fight this disease that affects our mothers and fathers, sisters and brothers, sons and daughters, grandchildren, even the person we buy our paper from—all the people we meet every day. Cancer is a blight on society, but if we continue to fight on, someday we will be able to say that we have won, and cancer has lost.

Caroline Flint: I am really glad to join friends this afternoon to pay tribute to Tessa’s work. I remember from the last Labour Government how, with Tessa and others, we kept our sanity even when the difficulties were on our own side—some things never change. We were accused of plotting at our dining club, but the only plots were about who would cook the next meal. What I remember is the laughter and joy of those soirées at each other’s homes.
Tessa was our first Public Health Minister, and I am so proud and glad that I am also part of that illustrious band. I am sure that she and her family would agree that Labour was best when it was at its boldest, and we have a chance to be bold by supporting Tessa’s initiative here today.

David Linden: I am grateful for the opportunity to sum up the debate on behalf of the Scottish National party, and to acknowledge speeches by the hon. Members for Croydon Central (Sarah Jones), for Dulwich and West Norwood (Helen Hayes), for Mid Norfolk (George Freeman), for Croydon North (Mr Reed), for Congleton (Fiona Bruce), for Hove (Peter Kyle), for Torbay (Kevin Foster), for Lewisham East (Heidi Alexander), for Redditch (Rachel Maclean), for Hampstead and Kilburn (Tulip Siddiq), for Ilford North (Wes Streeting), for Mitcham and Morden (Siobhain McDonagh) and for Strangford (Jim Shannon), and by the right hon. Members for Don Valley (Caroline Flint) and for Old Bexley and Sidcup (James Brokenshire).
As a new Member of the House this has been a very strange week for me, and it is the first time that I have felt quite a lot of emotions. Sometimes the public watch these debates and see Members of Parliaments slinging mud at each other across the Chamber, but no one could help but be moved by some of the incredibly personal speeches that have been made today, and that reminds those watching that we are all human beings after all. People have shared deeply personal stories, and it has been a real privilege to sit through this debate.
Like other Members, I pay tribute to Baroness Jowell for her bravery and for the moving speech that she made in the Lords. I know that when we watched that speech most of us were moved to tears, and I am glad she is here today. I also wish to acknowledge the late Dr Mo Mowlam. I was disappointed that she was airbrushed out of much of the media coverage of the 20th anniversary of the Good Friday agreement, because as an outsider looking in, I cannot help feeling that that agreement would not have been achieved without her. I am currently reading her book, and I cannot help but be moved by the effort that she put into Northern Ireland, and she did all that while going through an illness as well.
As an MP from Scotland, I want to offer a bit of experience from north of the border about our cancer strategies, and describe the commitment and improvement that we want for children and young people with cancer—I will return to that point. There is no doubt that we face many challenges, not just in Scotland but across the UK, when it comes to cancer. One problem we need to grapple with is obesity, which is the second highest cause of cancer. We must be as bold about diet and obesity as we have been about tobacco and alcohol, and everyone should consider that. That is definitely a challenge for me—my colleagues are not here, but they know that I do not have the best diet in the world, and diet and food choices are a real challenge when combating obesity.
We must also channel some focus on to free school meals and the choices made by children. Sometimes we think that cancer is just bad luck or something that comes to people, but there are things we can do to try to avoid it. For example, we know that advertising junk food harms people and puts pressure on the NHS, other public services and our economy. There is clear evidence of the need to curb the marketing of food and drink that is high in fat, salt and sugar. A large number of 11 to 18-year-olds have seen television adverts for those foods, and nearly half of those surveyed had made a purchase based on the marketing they had seen in previous days. We should consider banning such adverts during programmes for children and those under 16, because if we are serious about tackling obesity and reducing the prevalence of conditions such as type 2 diabetes, we must make it as easy as possible for young people to eat healthily and have a good diet. That means seriously reconsidering the marketing of unhealthy food and drink, and reducing exposure to such advertising on TV.
Before I conclude I want briefly to consider cancer and young people. We know from CLIC Sargent that around 4,000 children and young people are diagnosed with cancer every year in the UK. Every day, 11 children and young people hear the news that they have cancer, and every week 10 children and young people die from cancer in the UK. Cancer is the most common fatal disease for teenagers and young adults in the UK. CLIC Sargent’s 2016 research found that young cancer  patients often had a long and difficult route to diagnosis, which they felt had a detrimental impact on their treatment and experience.
Cancer costs families in many ways, including financially, as parents report an average additional expense of £600 for every month that their child is on treatment—the hon. Member for Ilford North touched on that. Some of the expenses are travel, extra food, energy bills and car-related costs, including parking. Families are travelling an average of 440 miles a month to access treatment for their children. At this juncture, I want to commend the right hon. Member for Harlow (Robert Halfon), who has been an assiduous campaigner in calling on the Government to scrap hospital car parking charges in England—they do not affect us in Scotland—for young cancer patients and their families.
We have had a good and very moving debate, and I am sure we will return to this subject again, hopefully with more progress. I close by thanking the hon. Member for Croydon Central (Sarah Jones) for giving us the opportunity to discuss this hugely important topic. Above all, I want to thank the noble Baroness Jowell for joining us here today. We are all the richer for having her with us.

John Bercow: Just before I call the shadow Minister, I would like to emphasise that I would like the hon. Member for Croydon Central (Sarah Jones) to be able to briefly wind up the debate no later than 4.57 pm. Members can do the arithmetic for themselves.

Sharon Hodgson: It is a genuine pleasure to be speaking in this debate on behalf of the Opposition. Indeed, I am speaking in this Chamber for the second time today. Both debates have been on very important issues.
I thank my hon. Friend the Member for Croydon Central (Sarah Jones) for securing the debate, and for her very moving and emotional speech. I also want to thank the other hon. Members who have spoken in this excellent debate: the right hon. Member for Old Bexley and Sidcup (James Brokenshire), my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes), the hon. Member for Mid Norfolk (George Freeman), my hon. Friend the Member for Croydon North (Mr Reed), the hon. Member for Congleton (Fiona Bruce), my hon. Friend the Member for Hove (Peter Kyle), the hon. Member for Torbay (Kevin Foster), my hon. Friend the Member for Lewisham East (Heidi Alexander), the hon. Member for Redditch (Rachel Maclean), my hon. Friends the Members for Hampstead and Kilburn (Tulip Siddiq) and for Ilford North (Wes Streeting), my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh), who moved us all to tears, the hon. Member for Strangford (Jim Shannon), my right hon. Friend the Member for Don Valley (Caroline Flint) and the hon. Member for Glasgow East (David Linden). They all made excellent contributions. Members throughout the House have been visibly moved by the moving testimonies we have heard.
As has been said, no one in the House or in the country escapes being touched at some time in their life by cancer. I lost my mother-in-law to breast cancer 21 years ago. That was one of the reasons why I joined the all-party group on breast cancer and work with it to  this day. I thank the Secretary of State for being here. I am very pleased to see him back in place. I know that Tessa and others will be very grateful for his attendance, and for the personal and moving tribute he gave earlier. I also thank the shadow Secretary of State, who also made a personal tribute to Tessa.
I pay enormous tribute to our very good friend and colleague from the other place, Tessa, for her bravery and determination, and for the outstanding speech she gave in the other place. That was another occasion when people were visibly moved to tears, not just in the other place but across the country as it ran on the news all day. She is as much an inspiration now as she has always been throughout her political career. In 1997, as we have heard, she became the first Public Health Minister—she is a predecessor of the Minister who will be responding today. With the then Secretary of State for Education, Lord Blunkett, she set out to build Sure Start, the early years programme of which she should be immensely proud. It has transformed the lives of tens of thousands of children across the country and been a lifeline for parents, some of whom have said that without it they do not think they would even be here today.
I am enormously proud to have played, in a very small way, a part in continuing the fight for early years provision over 20 years on. When I became shadow Children’s Minister, Tessa’s personal support, advice and guidance were invaluable in helping me fight to protect the legacy she had built. I remember one particular conversation when she said that she had told her officials that she wanted to walk into a Sure Start children’s centre and be able to smell the babies, so she would know the centres were being used and that lives were being changed.
Tessa’s optimism and ambition has affected us all over the years, especially in the run-up to, and in the aftermath of, the 2012 London Olympics, which, as we heard in detail, she secured as Secretary of State for Culture, Media and Sport. Even since her diagnosis, Tessa continues to inspire us all with her hard work and determination. I wish her all the love in the world, and I really look forward to joining her a little later with her friends and family for a get-together.
As Tessa said in the other place:
“Today…is not about politics but about patients”.—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1169.]
I know from my work over many years chairing or co-chairing two cancer all-party groups that we can and do work together when it comes to tackling cancer. The Minister and I co-chaired the all-party group on breast cancer, along with the former hon. Member for Mid Dorset and North Poole, Dame Annette Brooke. I am still vice-chair of that all-party group, and I pay tribute to my fellow officers for continuing their hard work in the group to raise awareness in Parliament of breast cancer.
I also chair the all-party group on ovarian cancer. Observant Members may have noticed that there is always some cancer campaign going on, and last month it was Ovarian Cancer Awareness Month. For the first time, the all-party group hosted a drop-in photo call, challenging MPs and peers to be a “teal hero”. This included wearing a superhero mask and a cape—I do  not know whether the Minister came along and managed to get caught—to raise awareness among our constituents of the signs and symptoms of ovarian cancer. I am sad to say that my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), who lost his mum to ovarian cancer when he was a teenager, came along and, complete with a superhero pose, pipped me to the post for “best picture”. I hope that colleagues will join me again next year—I will be looking out for the Minister. Although it was fun, it was for a very important purpose: to raise awareness of the symptoms of ovarian cancer.
Finally in this regard, I pay tribute to the hon. Member for Basildon and Billericay (Mr Baron) for his sterling work as chair of the all-party group on cancer, which regularly unites all the cancer charities and all-party groups in debates and in work throughout the year, and most notably at the Britain Against Cancer conference every December. All-party groups and the many other cancer groups are the perfect example of how cancer is not about politics. I believe that we have seen that exemplified in its best form in the House today, and that in future we can put our politics aside for Tessa and for all cancer patients and truly fight cancer together.
Around 11,400 people were diagnosed with a brain or related tumour in 2015 in the UK. That includes the approximately 470 children under the age of 15 who are diagnosed with a brain or related tumour in Britain each year. I also commend HeadSmart for the work that it does to raise awareness of the symptoms of brain tumours in children. Brain tumours are the largest single cause of death from cancer in adults under the age of 40, and the most common type of solid tumour in children.
There are, of course, challenges to brain tumour research that limit progress in developing innovative treatments. As we have heard, brain tumour research in the UK has been grossly underfunded, with just 1% of the national spend on cancer research being allocated to this devastating disease. That is why the recent announcement that £45 million would be invested in brain tumour research was so very welcome. I hope that some of the funding will be used to create opportunities for collaboration so that research and data can be shared around the world, because there are real and concerning gaps in the research workforce, both at a senior level and in the number of junior researchers entering the field.
There is also insufficient infrastructure for brain research, and the research community is fragmented, with no clear hubs of excellence and limited opportunities for collaboration. We need to address those challenges for the sake of patients and their families so that we can improve the lives of those living with a brain tumour. One way to do that is to ensure that all brain tumour patients are invited to participate in clinical trials, which can lead to significant improvements in survival and quality of life for future patients diagnosed with a brain tumour. However, despite the clear correlation between greater research and improved outcomes, only 3% of people with a brain tumour take part in a clinical trial. That compares with 7% across all cancers, so what steps is the Minister taking to ensure that brain tumour patients are entered into clinical trials?
In June 2017, the Brain Tumour Charity conducted a survey that found that 97% of those with a brain tumour said that they would be happy to share their medical data to help to accelerate research. As we have heard,  Tessa has made the historic decision to be the first patient to consent to sharing her data in the hope that her cancer journey can contribute to new cures that alleviate future suffering. Let me again take the opportunity to commend her for her selflessness. I know that where she leads, others will naturally follow.
For Tessa, the Olympic legacy and Sure Start are just two of many legacies to be proud of, but I think that this legacy will be even greater in its reach and importance. For that, we once again thank you, Tessa.

Steve Brine: On one of the hottest days for a long time, and certainly the hottest day of the year so far, being inside the House of Commons and listening to some of the speeches that have been made has been an absolute privilege. It has been an experience that I, as a Minister—let alone as a Member of Parliament—will remember for a long time.
Let me first thank the hon. Member for Croydon Central (Sarah Jones) for securing the debate. I thought she spoke brilliantly, and set the tone for the last two-and-a-bit hours. But we should not beat around the bush: we are all here primarily because of one person. That person is, of course, Baroness Jowell, who is present, sharing the Chamber with us, and whose strength and grace in the face of her illness have done so much to raise public awareness of the challenges of diagnosing and treating brain cancer. I do not have a long history of knowing the Baroness—in fact, I met her for the first time on Monday—but I am already well aware of her strength of character and her determination to make a difference in this latest campaign.
Like all Members, and especially, I suppose, as the current Minister responsible for cancer issues, I was captivated by the speech that Tessa made in the other place about her latest battle. Our debate today has been emotive and constructive, and I am grateful to the many Members who have had the opportunity to pay a similarly worthy tribute to Tessa’s bravery and determination in the House of Commons. For me—and many Members have said the same—perhaps the most memorable line of the Baroness’s speech in the other place was this:
“In the end, what gives a life meaning is not only how it is lived, but how it draws to a close.”—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]
She is giving that line great meaning.
As has been mentioned many times, Tessa also referred in her speech to the importance of living with cancer—living longer with cancer, but living with cancer. As one who was motivated to go into this business in the House by fighting and losing far too many battles against cancer, I would say that, for all of us who are diagnosed with cancer, we are never just our cancer. Tessa is not just her cancer, and she is not just the cancer campaigner that she is now. She is still a mum, and she is still a wife. You spoke at the start, Mr Speaker, about the love. There has been one hell of a love bomb here today. When I have been able to, I have looked over at the Under Gallery, and I have certainly seen some love there this afternoon. It has been incredible and very moving to see it.
I think that what made that line in the speech in the other place so remarkable is that Baroness Jowell has given so much to our country, from being my predecessor  as the first ever public health Minister to giving the country one of its greatest cultural events in London 2012. Through her enthusiasm and courage, she is driving people in the country and around the world to confront not just one of oncology’s most difficult challenges, but one of medicine’s most difficult challenges. We should not underestimate what a difficult challenge brain cancer is.
Let me say on behalf of the Government that we will do everything possible to meet the challenge. Those who know me as the cancer Minister know that I am impatient and determined—as is the Secretary of State—to do well, to do better, and then to do better again in fighting the big C, or cancer, or whatever we choose to call it. I say that not out of arrogance or ministerial bluster—I write my own speeches—but because I believe that this challenge is one that we can overcome. I was truly inspired when meeting the Baroness for the first time on Monday at the inaugural meeting of the UK brain tumour steering group, so ably chaired by my colleague Lord O’Shaughnessy, who I know has already become a firm friend of hers. So in my brief remarks I shall focus on three areas where we will do more, and which sum up pretty much what every Member covered in their speeches.
The first area is research. On 22 February, just a month after the Baroness’s powerful speech, Department of Health and Social Care Ministers met Tessa and representatives from the Eliminate Cancer Initiative at the Cabinet Office to try to find solutions to improving outcomes for people fighting brain tumours. That very day the Department’s task and finish working group into brain cancer research published its report on brain cancer research in the UK, setting out how to increase the level and impact of research into brain tumours going forward. The group was set up in 2016 and was chaired by the Department’s chief scientific adviser Professor Chris Whitty. It brought together clinicians, charities, patients and officials to discuss how, working with our research funding partners—key in this—we can address the need to increase the level and impact of research into brain tumours.
To back the report, as all Members will know, the Government and Cancer Research UK together announced an investment of £45 million over the next five years to turbocharge research in this area. This will begin—but only begin—to make up for the historical lack of research in this field and further strengthen a number of our existing centres of excellence in places such as Cambridge and the Institute of Cancer Research here in London.
The National Institute for Health Research spent £137 million on cancer research in 2016-17, the largest investment in any disease area. However, according to Brain Tumour Research, even though brain tumours kill more children and adults under the age of 40 than any other cancer, as has been said, just 1% of the national spend by all cancer research funders on cancer research has been allocated to brain cancers. That is why—as everyone has said today—we want to move quickly on beginning further research, and I am pleased to say that the NIHR began inviting applications for the new funding this Monday. We urge researchers to apply, and help us generate the breakthroughs that could give hope to the thousands of people diagnosed with brain cancer every year in our country.
My second point is on data sharing. We know that, due to the rarity of many types of brain tumours, it is vital that we use patient data more effectively—the hon. Member for Hove (Peter Kyle) spoke very well about that—ensuring that it is shared safely, securely and lawfully not only between the NHS, charities and academia, but between like-minded countries internationally. The UK has a proud history as a proponent of open data and data sharing, and I give my Government’s commitment to work with the Eliminate Cancer Initiative and partners nationally and internationally to make this a reality on brain tumours. The ECI made the point at our meeting on Monday that patients’ data must be given for the common good, not the almighty shilling; I know that Tessa shares that sentiment. Tessa’s daughter, Jess—who is also here today and whom I met on Monday—said that we support and advocate the sharing of data not as an end in itself, but as a vital means through which to improve patient care and develop new treatments; she is of course a chip off the old block and absolutely right.
Baroness Jowell exemplifies the ambition we have, and we will carry it forward. In the Houses of Parliament tonight, Tessa will launch the global universal cancer databank, and has committed to be the first donor to that databank, which we hope can catalyse the sharing of data across the world and save the lives of many. My right hon. Friend the Secretary of State will be pleased to be there.
Thirdly, and most importantly, I want to touch on patient engagement. We must ensure that patients are at the centre and heart of our work on brain tumours, so we will build on the existing work to develop a clear timeline and plan for reducing the time to diagnosis for brain tumours, which is as important in this cancer as in all others. We will also implement new models of patient care, such as the Cambridge model, and the national roll-out of innovative new tools such as the 5-ALA ‘Pink Drink’, which is very important. The National Institute for Health and Care Excellence is currently developing a new clinical guideline on brain tumours, which includes the use of 5-ALA, with publication expected in July. We will also redouble the Department’s efforts to ensure there are appropriate and ethical frameworks to allow patient access to experimental medicines, and allow for the re-purposing of drugs and the acceleration of the development of new patient-focused adaptive clinical trials, which is so important.
Many Members have spoken so well in this debate. I will not list them all, but it was a pleasure to see my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) back in his place, making his first speech from the Back Benches in a long time. I worked closely with him when he was in the Northern Ireland Office; he is one of the nicest guys in Parliament and he spoke brilliantly about #KeepOliviaSmiling—and it was good to see my right hon. Friend smiling again. He talked about ring-fencing money in the NIHR for brain tumour research for children. The level of research spend in a particular area, such as child-specific tumours, depends on the number and scale of successful funding applications. He will be aware of our joint announcement in February, which included the opening of Cancer Research UK’s new children’s brain tumour centre of excellence at the University of Cambridge. Maybe he will go along and have a look at that at some point.
My hon. Friend the Member for Congleton (Fiona Bruce) spoke well about prostate cancer, and I was proud that we were able to make that announcement last week. My hon. Friend the Member for Torbay (Kevin Foster) spoke about the ACE programme. I have said before that I do not easily get excited at the Dispatch Box, but I am genuinely excited about these new ACE multidisciplinary diagnostic centres. When people present to their GP with vague symptoms, these centres will provide a chance for them to get in and get an answer—a diagnosis or an all-clear—quickly. I visited one of the ACE centres, at the Churchill Hospital in Oxford, in February this year. The enthusiasm that I heard from the clinicians and patients there gave me real hope, and hope is a key word in today’s debate.
I should like to conclude by once again thanking everyone who has made such positive contributions to what has been a really memorable debate. I recognise that we are only at the start of our journey to beat brain tumours, but now is the time for patients, the NHS, charities and industry to come together—as we in this House have done today—both nationally and internationally and to redouble our efforts. The funding we have committed for additional vital research, and our ongoing work to look at every aspect of diagnosis, treatment and care, will help us to deliver ever more positive treatment outcomes for people with brain tumours, but we have a long way to go. This is of course happening alongside our system-wide transformation of cancer services in England through the cancer strategy, which we have debated at length here many times.
Baroness Jowell has been the catalyst for this rapid activity on brain tumours, and it is incumbent on us all to continue to work closely together over the coming months and years to build on this legacy. She is here today, and I know that she will be watching us closely. As Theodore Roosevelt once said, now is the time for
“painful effort…grim energy and resolute courage”
to beat this terrible disease. And, as I always conclude: for team cancer, the fight goes on.

Sarah Jones: I should like to thank everyone who has spoken so eloquently and movingly today. I cannot name everyone in the time remaining, but I often stand in awe of the Members of this House, and no more so than today. We have had quite a harrowing week in this place, and it has sometimes been quite dark and difficult. There has been a lot of shouting. However, we have closed the week by talking about human kindness, compassion, love and hope. That is what a drop of Tessa magic does for this place. When I saw Tessa just before the debate, she said that this was not about her or about us, and that she wanted it to be about what comes next and what we should do. I hope—and I have faith—that the Government will prove that Tessa’s model of collaboration is more effective than the model of confrontation that we have unfortunately seen so much of this week.
I have here a note from Tessa that I would like to read out. This is odd, because she is just over there, and she could say this herself, but I shall read out a little bit of what she wanted me to say today:
“Living with cancer has taught me so much. I have been so lucky to be surrounded by such love from my family, friends and fellow cancer patients. And today, hearing so many of you talk  about your own fights, reminds me why I love this Palace of Westminster and the people who work here. It was a brilliant Member of this House, who spent far too short a time here, who said ‘we have far more in common than that which divides us’, and today shows how much we can do when we all put our shoulders to the wheel. It was the honour of my life to be one of you, and I shall cheer on from the sidelines as you keep fighting the good fight. So remember our battle cry: living with, not dying of, cancer. For more people, for longer. Thank you.”

John Bercow: In rounding off these proceedings, before we move to the Adjournment, perhaps I can thank warmly and from the bottom of my heart the hon. Member for Croydon Central (Sarah Jones) for securing the debate, for what she said in opening it and for the manner in which she did so. I think I speak for everybody in thanking all participants in the debate, both those who made speeches and those who intervened with great piquancy and significance—I say that looking directly at the Secretary of State for Health and Social Care, and, in his absence, thinking of the shadow Secretary of State. Their presence meant an enormous amount.
At the outset of the debate, I asserted with absolute confidence that Tessa was about to witness and experience real parliamentary love—the embrace of parliamentary love. I hope that the warmth of that embrace of parliamentary love has been manifest to her. She cannot have been in any way disappointed by it. Tessa, you are the standing testament to the indomitability of the human spirit and we have heard about that from people who know you so well in so many aspects of your life. I am quite certain, although I do not know it from personal experience—I can see it from the impact on those around you—that it is true of you as a wife and as a mother. It is assuredly true of you as a distinguished Member of Parliament—the Member, for so long, for  the people of Dulwich and West Norwood. I thought that what your successor said about the affection and esteem in which you continue to be held there was worth everything.
It was most certainly true of you as a Government Minister, the details of which have been lovingly recalled to the Chamber this afternoon. Of course, we all know of the significance of what you did on the Olympics and, if I may say so, the significance of what you did by way of Sure Start and early years opportunity. When I briefly did a little work in a support capacity on speech and language services a decade ago, I trogged around the country—what a privilege it was—and visited huge numbers of such settings. There is absolutely no doubt whatsoever that the work you did and the translation from conception to execution transformed the lives of some of the most vulnerable of our fellow citizens. That is part of your amazing public service legacy.
As somebody who is living with cancer you have shone a light on a cruel curse and the need for collaborative, resourced and unflagging devotion to the effort to tackle that curse. The hon. Member for Croydon Central, quoting your letter, said that you loved this place. I hope that it is blindingly obvious to you, Tessa, that we love you—[Applause.] These breaches of parliamentary protocol are becoming more commonplace, but I think that this week we can rejoice in them.
Question put and agreed to.
Resolved,
That this House pays tribute to the work of Baroness Tessa Jowell in her campaign to help people with brain tumours to live better lives for longer; recognises the Government’s increased funding for research; and calls on the Government to increase the sharing of health data and promote greater use of adaptive clinical trials.

FIRE SAFETY REMEDIAL WORK: LEASEHOLDER LIABILITY

Motion made, and Question proposed, That this House do now adjourn.—(Kelly Tolhurst.)

Marsha de Cordova: I am pleased to have secured this important debate. The issue of liability for fire safety remedial work is of great concern to many Battersea residents, as it is to people in many parts of the country, and for good reason. The horror of the Grenfell fire made it clear, if greater clarity were needed, that there should be no complacency on fire safety.
While we await the final publication of the Hackitt review, which is investigating the fire safety regulatory system and identifying who is responsible for failures and what system is needed, the interim report stated that the regulatory system, at present, is “not fit for purpose.” I fear that is the result of successive Governments not treating fire safety with the appropriate importance.
Of the 158 social housing blocks with unsafe cladding, just seven have had the cladding fully replaced. One of the blocks waiting for work to begin is Castlemaine Tower in my Battersea constituency. Its residents have known for 10 months that their building, like Grenfell, has unsafe cladding. No data is available on the progress on privately owned blocks, and Wandsworth Council has not published the number of blocks that have the aluminium composite material cladding that has been deemed unsafe. Given the number of blocks in Battersea, it is imperative the council publish that information. I have requested the information from the Secretary of State for Housing, Communities and Local Government.
The Government must get their act together and ensure that fire safety work is carried out, but to do that they need to resolve, as a matter of urgency, questions on what work needs to be done, who needs to do it and who should pay for it. It is the Government’s responsibility to resolve those questions and, so long as they do not do so, the risk of another tragedy is prolonged.
Here we arrive at the crucial question of leaseholder liability. I welcome members of the Sesame Apartments residents association to the Public Gallery. They have come to Westminster desperate to hear reassurance from the Government. They are leaseholders of an apartment block in Battersea that was completed just four years ago and that last year was found not to meet fire safety standards after a fire in the block damaged multiple apartments, revealing that compartmentalisation had failed.
Worryingly, the fire occurred while a “stay put” policy was in place. Subsequent testing found that the cladding was defective and in need of replacement. In light of the fire safety failures, the “stay put” policy was changed to immediate evacuation, and a waking watch system was put in place as a temporary solution.
As we know, such fire safety failures need proper rectification, and that work needs to be paid for. The waking watch and fire alarm system are anticipated to cost approximately £700,000, which is more than £8,500 per flat. Replacing the cladding is expected to cost around £2 million, which is £25,000 per flat. In total, the cost per flat is estimated at between £30,000 and £40,000.
After a tribunal ruled last month that leaseholders of Cityscape in Croydon would be held liable for replacing defective cladding, the residents of Sesame Apartments fear the entirety of those eye-watering costs will fall on their shoulders, which cannot be right. They cannot be held liable for these costs. These are hard-working people who scrimped and saved to buy their flats.

Steve Reed: I congratulate my hon. Friend on securing this debate. She mentions Cityscape in Croydon North where the leaseholders have a similar problem to the residents she represents. When the issue has previously been raised in the Chamber, the Government have pointed the finger and said that the insurers of the builders, freeholders and managing agents should be bearing the cost of removing and replacing that cladding, but no legal obligation has ever been found on any of them.
The Government are leaving leaseholders hanging with unaffordable debt and living in homes that have become unsellable—homes that they fear are not safe to live in. Does my hon. Friend agree that the Government should act now to get the cladding removed from every building where it exists? They can sort out the legalities afterwards. The only body in a position to act now to keep people safe is the Government. Why do they keep refusing to do it?

Marsha de Cordova: I thank for my hon. Friend for making that valid point, which I will certainly be addressing. He is spot on in saying that the Government are the only people who can respond to this issue and deal with the problems that our leaseholders face.
So many of these people are first-time buyers, and many are living in shared ownership properties. They do not have tens of thousands of pounds to pay for the work that needs to be done, and they have done nothing wrong. They bought their flats in good faith and they are in no way responsible for the fire safety failures. To date, the Government have seemingly agreed, saying that, morally, leaseholders should not be held liable for these costs. But my constituents need those words to be backed up by action. For as long as that does not happen, the leaseholders will be beset by fear. After all, how would we feel if we were told that our home did not meet fire safety standards, that we might be asked to pay £40,000 to rectify that and that our largest financial asset, our home, was now a huge liability? That is the situation that residents of Sesame Apartments find themselves in.
I have heard from a teacher who lives in the block and who had hoped to move in order to start a family, but is now weighed down by this liability, unable to sell and trapped in her home. I have heard from a resident, who spoke to me about the heartbreak of the money they had saved for IVF—in vitro fertilisation—treatment now needing to be set aside for fire safety work. I have heard from another whose pride in getting a foot on the housing ladder was crushed when they were told that, just by owning 25% of a shared ownership property, they are now potentially liable for 100% of the costs. Every resident I have spoken to tells me of the stress and fear caused by this liability hanging over their head.
The same is true of leaseholders across the country. Why are leaseholders being put through this ordeal? The Hackitt review is identifying who was responsible  for fire safety failures, but this is causing anguish. The review might conclude that the Government are responsible, because fire safety regulations are not fit for purpose. It might conclude that the building inspection regime is responsible, because some local authorities have privatised inspections, leading to a serious decline in standards. Or it might conclude that developers are responsible, because they have been cutting costs to maximise their profits. It might conclude any of or indeed all those things, but what it will categorically not conclude is that leaseholders are responsible—of course it won’t.
These are working people who have had no say over the regulations, or over the design or the building of the property, yet it seems that, legally, they are going to be held responsible for these life-shattering costs. As anyone would, they are attempting to contest that, but they tell me how powerless they feel in that process.
We are talking about a small community of hard-working people, but they are confronted by a web of opaque freeholders, management companies, insurers and unresponsive developers, none of whom wants to take responsibility. The residents do not have armies of lawyers at their disposal. It is a David and Goliath situation, and the law is not working for these people. But it not just about that, as for the corporations involved their profit lines are at stake, whereas for the residents it is their homes and their lives. There is a real concern that if this is allowed to run its course and the Government do not intervene, the working people will be paying for failures that are not of their own making—that is unacceptable.
The Government seem to recognise that, because they have already said on multiple occasions that they acknowledge that it is morally wrong for leaseholders to be held liable for these costs, but those must not be empty words. The Government have the power to intervene and make this right, and it is their responsibility to make this right. They need to do more than just encouraging freeholders not to pass on these costs. They need to do more than support the Leasehold Advisory Service. They need to step up to the plate and intervene on the behalf of leaseholders.
There are actions that the Government could take. They could, and should, properly look to see whether the developers or the freeholders that profited from cost-cutting and lax regulations are liable for the costs, or they could cover the costs themselves, which is what the residents I have spoken to believe should happen.
If the Government refuse to do that, the least they could do, as suggested by one of the Sesame Apartments residents, is provide loans to cover the costs, thereby allowing fire safety remedial work to begin immediately. The loans could be attached to the freehold and stretched over the 100-year duration of the leasehold, with repayment instalments reflecting that. That would ensure that if leaseholders were held liable, the additional yearly service charge would be close to negligible. It would achieve the key requirements of any intervention: first, it would allow remedial work to begin as soon as possible, thereby minimising the risk and fear of fire; and, secondly, it would allow leaseholders to get on with their lives and not be weighed down by an unaffordable debt. I urge the Government to take action to achieve those goals.
I conclude with two straightforward questions for the Minister. First, it might become clear from the courts that leaseholders are legally liable for the costs. If that  happened, does she think it would be acceptable? Put otherwise, does she think that residents should be held legally responsible for the costs of fire safety work, even though she knows that residents are in no way at fault?
Secondly, if leaseholders are found to be liable, what do the Government propose to do for those leaseholders who cannot afford the remedial work? I am asking, in essence, whose side the Government are on—David’s or Goliath’s. I thank the Sesame Apartments residents for coming today. I know that they will be listening with interest to what the Minister has to say.

Heather Wheeler: I thank the hon. Member for Battersea (Marsha De Cordova) for speaking so passionately about the situation in which some of her constituents find themselves. I thank all Members for their contributions. I recognise that the recent fire in Sporle Court will mean that fire safety is at the forefront of people’s minds in Battersea, although we understand that on that occasion there were no injuries.
Let me begin by making it clear in the widest sense that the Government are committed to promoting fairness and transparency for leaseholders in England. To that end, on 21 December 2017, we announced a package of measures to tackle abuses and unfair practices in the leasehold market. That includes introducing legislation to prohibit the development of new build leasehold houses other than in exceptional circumstances, and restricting ground rents in newly established leases of flats to zero financial value. We are working with the Law Commission to support existing leaseholders, including by making buying a freehold or extending a lease easier, faster, fairer and cheaper. With that context in mind, it is hugely important that leaseholders, like any other residents, are kept safe in their homes.
The fire at Grenfell Tower was a terrible tragedy. The Government are determined to learn the lessons and take all necessary steps to ensure that nothing like it can ever happen again. I wish to set out some of the steps that the Government have taken since the tragedy. The Department’s building safety programme, set up immediately after the fire, is working hard to ensure that all high-rise residential buildings are safe from the threat of fire, and that residents feel safe in them. To support that, the Secretary of State appointed an expert panel to ensure that the necessary steps are taken to ensure the safety of residents of high-rise buildings. Following the panel’s recommendations, the Government provided advice to building owners on the interim measures that they should put in place to ensure the safety of their residents. We swiftly identified social housing blocks and public buildings with unsafe cladding. All the affected social sector buildings that we have identified have these measures in place.

Steve Reed: The Minister will recall the lethal fire at Lakanal House in 2009. In 2013, the coroner who investigated that tragedy urged the Government to change the fire safety regulations that govern the use of cladding—specifically, approved document B. The Government failed to amend that regulation in 2013 and now, five years later, they have still failed to amend it. The criticism was that it was unclear what kind of cladding could and could not be put on a building. For that reason,  flammable cladding exists on hundreds of blocks today. Will the Minister explain why the Government have done nothing in the nine years since Lakanal House?

Heather Wheeler: The important thing is that the Hackitt review has already released interim recommendations, which we have accepted. We await the review to report later this summer. That will be the answer going forward.
All the social housing blocks and affected social sector buildings that we swiftly identified had the measures in place. In parallel, we tested different combinations of cladding and insulation to see which of them met the building regulations guidance. We published consolidated advice in September, confirming the results of the tests with advice for building owners. We have also been working with building owners and industry to support remediation work.
At the same time, the Government asked Dame Judith Hackitt to undertake an independent review of building regulations and fire safety to ensure that buildings are safe in future. We are taking forward all of the recommendations for Government contained in the interim report, and look forward to the publication of her final report shortly.
We believe we have identified all affected social housing blocks and public buildings. With regard to private sector buildings, the Government have made the testing facility at the Building Research Establishment available free of charge, and we continue to urge all building owners to submit samples for testing if they think that they may have unsafe cladding. In addition, the Secretary of State wrote to all local authorities in August asking them to identify privately owned buildings with potentially unsafe cladding in their area in line with their statutory duties.

Marsha de Cordova: On that point, my local authority, Wandsworth Council, has still not published any information around those private blocks that could potentially have flammable cladding. Will the Minister take it on herself to continue to press the council to get on with the job and publish the information? She made the recommendations last summer.

Heather Wheeler: I hear what the hon. Lady says. We have close contacts with Wandsworth Council.
In addition, the Secretary of State wrote to all local authorities in August asking them to identify these properties. The majority of local authorities recognised the urgency of that work and provided relevant information, and we are very grateful for their hard work. However, this is not a straightforward task, particularly when building owners cannot be traced or are unresponsive. We have been in constant dialogue with local authorities ever since. Last month, to support local authorities in that work, we announced a financial support package of £1 million to assist the most affected local authorities in identifying the remaining private high-rise buildings with potentially unsafe cladding.
We are progressing work to issue a statutory direction as to local authorities’ reviews of housing conditions in their area in respect of cladding-related issues. We are also working to publish additional operating guidance to support local authorities in assessing the risks to residents posed by potentially unsafe cladding.
These measures will help local authorities to take enforcement action to ensure that hazards in residential buildings in their areas are remediated as quickly as possible. I am confident that these steps will strengthen local authorities’ hands when carrying out this work. I can assure hon. Members that, as soon as we are notified of buildings with potentially unsafe cladding, we work with local authorities and the National Fire Chiefs Council to ensure that interim measures are put in place.
The Government have been clear that remediation should be done as quickly as possible, but it should also be done properly. Let us be clear: the remediation of buildings with ACM cladding is a complex process, involving major construction work which needs to be planned, consulted on and carried out carefully. Rushing any phase of the remediation process could jeopardise the safety of residents. I am encouraged that remediation has started on 103 affected social sector buildings and that, of those, seven have finished remediation work. There is clearly a long way to go, but that is significant progress.
I understand that funding is a concern for Wandsworth Council. In the social sector, all the local authorities and housing associations that we have spoken to have indicated that they have no plans to pass on the costs of essential remediation work to individual flat owners within their buildings. We will consider financial flexibilities for local authorities that are concerned about funding essential fire safety works to the buildings that they own.
In the private sector, we continue to urge those with responsibility to follow the lead from the social sector and not attempt to pass on costs. They can do that by meeting costs themselves or looking at alternative routes such as insurance claims, particularly warranties, or legal action.

Steve Reed: Will the Minister give way?

Heather Wheeler: No, I am going to finish.
We are aware of cases in Battersea where freeholders are seeking to do just that.

Steve Reed: Will the Minister give way?

Heather Wheeler: No, thank you.
Where building owners are seeking to pass on remediation costs to leaseholders, it is important that leaseholders can access specialist advice to understand their rights. We have provided additional funding to the Leasehold Advisory Service—LEASE—which provides independent, free, initial advice to leaseholders to ensure that they are aware of their rights and are supported to understand the terms of their leases. LEASE continues to provide valuable support to affected leaseholders around the country. On 15 March, the Secretary of State announced an industry roundtable on the barriers to the remediation of buildings with unsafe aluminium composite material cladding.

Steve Reed: Will the Minister give way?

Heather Wheeler: No, I will not.
I hope that the points I have made have reassured—

Steve Reed: Will the Minister give way?

Heather Wheeler: No, I will not, sir.
I hope that the points I have made have reassured hon. Members just how seriously we are treating the building safety issues that the terrible fire at Grenfell Tower  brought to light, and our commitment to supporting leaseholders and all residents throughout this process.
Question put and agreed to.
House adjourned.